# When to cut away a patient's clothes?



## musicislife

When is it necessary, and when should it not be done?


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## Achilles

I cut a PT's clothes when I have to and I don't when i don't need to.


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## Handsome Robb

When they can't take them off for themselves. I always tell them "I need your shirt off" and if they refuse or can't help me get it off of them snip snip snip.

When you need to expose something and it isn't practical to ask them to remove that piece of clothing. I.E a leg injury and tight jeans. 

Achilles, no need to be a smartass.


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## medicdan

When it's necessary for you to inspect or palpate an area of the body not otherwise accessible, or not easily accessible without exacerbating said injury. Unresponsive multi-trauma victim may be an example... 

With all of that said, one rule. Never cut down-material. Ever.


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## Hunter

Between the ages of 18-25 y/o f patient bmi of <20...

Only when it's a necessity to examine your patient, usually when the patient can't help you and you need to assess everything fast.


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## Pneumothorax

ABCDE's E is for environment/expose....

Cut to expose or otherwise necessary cut on a toe doesn't mean rip pants off


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## bigbaldguy

It's also worth mentioning that if time is not critical try and cut along seams or in non obvious spots if they're wearing nicer clothes. Slicing through someone's 150 dollar pair of jeans can be a little traumatic for some folks. If you tell them your're going to follow the seam so they can be repaired by a good tailor it is on less thing they have to stress about.


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## EMT John

Any major trauma is going into the trauma room with only their underwear on... otherwise just expose the area of injury.


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## Sasha

When I want to palpate their six pack and nice pectorals.


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## Sasha

That aside, as I work IFT my patients often come pre exposed or wearing an easily removable gown. Sometimes the clothes are layered on and that's a PITA.

I remove it only as necessary for examination and treatment. Applying 12 leads or investigating complaints.


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## Aidey

emt.dan said:


> With all of that said, one rule. Never cut down-material. Ever.



My number one rule is that you do not cut down anything in my amb. If you do, you are riding in and helping clean up. Period. Those little feathers are like :censored::censored::censored::censored:ing christmas tree needles. Just when you think you've got them like cleaned up, more come out of the woodwork.


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## mycrofft

You only cut when you need to bare something and it can't be conveniently bared by disrobing; to extricate; to decontaminate; and either if the pt has inability to consent (altered mentation or unconscious) and it is imperative that the area be seen/etc quickly. 
And when local protocols demand.

I once cut the shirt off a guy in the ER. He was sitting quietly by himself, was pale, diaphoretic, holding very still and tripoding and said "I don't feel so good". He wasn't having a MI, he had a middle ear disorder and was waiting for his wife to pick him up. Had to go home with a hospital gown on as a shirt.


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## NomadicMedic

EMT John said:


> Any major trauma is going into the trauma room fully naked (aka "trauma striped") and covered with blankets to prevent hypothermia... otherwise just expose the area of injury.



fixed that for you.


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## zmedic

EMT John said:


> Any major trauma is going into the trauma room with only their underwear on... otherwise just expose the area of injury.



yeah, i second this. It pisses me off when EMT-Bs call a trauma notification and bring me the patient fully dressed. They are basics, they weren't starting an IV. They should have already done a rapid trauma exam on scene before backboarding the patient. So other than getting a set of vital signs what the heck are they doing on the way to the hospital? Start cutting.


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## musicislife

what do you mean by "cut down"


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## TB 3541

musicislife said:


> what do you mean by "cut down"



I believe they are referring to feather-filled garments, like a heavy winter jacket.


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## EMSpursuit

Trauma assessment def need to cut some clothes I would think...


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## medic417

EMT John said:


> Any major trauma is going into the trauma room with only their underwear on... otherwise just expose the area of injury.


If I'm cutting that much off they ain't gonna have underwear left.


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## EMT John

medic417 said:


> If I'm cutting that much off they ain't gonna have underwear left.



Whats the point of bringing them in nude? Can you not lift a piece of underwear to scan an area? I mean if they're wearing some long johns and/or a corset, then sure cut those thing off. But I feel that people need dignity as much as the next person.


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## Handsome Robb

12-leads aren't usually a good reason to cut something either. I can place a 12-lead without exposing a woman's chest, or a man's chest for that matter and still get them in the right spot. 

I'm with John, they can keep their underwear and women can keep their bra as well, if it's that bad that the bra needs to come off you can be sure I'm not going to do it until we are in the truck and then I'm going to cover her up with a towel or a scrap of her leftover shirt. Everyone deserves their dignity, even if they are in an ambulance.


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## Aidey

EMT John said:


> Whats the point of bringing them in nude? Can you not lift a piece of underwear to scan an area? I mean if they're wearing some long johns and/or a corset, then sure cut those thing off. But I feel that people need dignity as much as the next person.



The point is that they are going to get stripped of anything they are still wearing within about 2 minutes of getting into the trauma room. These patients are getting multiple interventions at once in preparation for advanced imaging or surgery. If I bring in a major trauma pt they automatically get a second IV line, intubated if they aren't already, a chest x-ray, a foley cath and possibly a chest tube before leaving the ED.


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## EMT John

Aidey said:


> The point is that they are going to get stripped of anything they are still wearing within about 2 minutes of getting into the trauma room. These patients are getting multiple interventions at once in preparation for advanced imaging or surgery. If I bring in a major trauma pt they automatically get a second IV line, intubated if they aren't already, a chest x-ray, a foley cath and possibly a chest tube before leaving the ED.



All which can be done with underwear on. One snip bra comes off and there's your chest tube and X-ray. People don't need to be paraded around like some kind of show. Dignity is going to lessen stress and provide trust/repor with my pt  which in the long run helps the pt. I don't need to continuously stare at someones goodies. I can palpate a chest through a bra and check a pelvice through some chones.


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## AmeriMedic21

If i am needing to do a rapid trauma assessment, or if there is significant injury and I need to take a look and the clothing wont move out of the way. I remember I had to splint a guys leg because he had a possible tib/fib fracture, and I had to cut off his cowboy boot because we couldnt get them off either way. He was pissed, but understood that I had to check PMS


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## EMT John

AmeriMedic21 said:


> If i am needing to do a rapid trauma assessment, or if there is significant injury and I need to take a look and the clothing wont move out of the way. I remember I had to splint a guys leg because he had a possible tib/fib fracture, and I had to cut off his cowboy boot because we couldnt get them off either way. He was pissed, but understood that I had to check PMS



I know what you mean. I cut off I guys brand new leather riding jacket, easily $500 along with his pants and boots. But you gotta do what you gotta do. They guy was very upset like you said but he got over it. If you don't want your nice things cut up don't lay down your bike. -_-


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## Handsome Robb

AmeriMedic21 said:


> If i am needing to do a rapid trauma assessment, or if there is significant injury and I need to take a look and the clothing wont move out of the way. I remember I had to splint a guys leg because he had a possible tib/fib fracture, and I had to cut off his cowboy boot because we couldnt get them off either way. He was pissed, but understood that I had to check PMS



There's still no reason to cut away someone's underwear or bra. You can easily look around those items. The person is going to be anxious and upset already if they are in a situation where you are making them "trauma naked", if they are awake. Personally I like to try to lower my patient's anxiety levels rather than raise them. Making them totally naked, especially women, around a bunch of firefighters, who are generally men, is counter productive to my goal.

Aidey I agree with you on everything else. I'll nab a second line, intubate them if appropriate and it's possible since we don't carry RSI meds.


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## mycrofft

This thread has remained remarkably subdued and professional, versus the usual we've had in the past.h34r:


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## Akulahawk

If I have to strip a patient, I'm going to do it by however and whatever means necessary. That doesn't mean that I'm going to expose the patient to the world unnecessarily. One snip and a bra opens to expose the full anterior chest. Two more snips and it stays on the gurney... Two snips of the underwear and I can get at the entire pelvis and perineum. That doesn't mean that I'm going to just leave the patient that way. It means that I can flip the fabric back up and cover those parts and provide for modesty as much as possible. 

One trauma patient I had, I'd stripped him down to his underwear. Had I not snipped off that too, and exposed him completely, I would have missed that his scrotum was quite enlarged, full of blood. That event would not have been good...


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## Bosco578

Aside from various trauma that requires exposure,cardiac arrest pt's get there shirts/jacket/bra cut.


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## Akulahawk

mycrofft said:


> This thread has remained remarkably subdued and professional, versus the usual we've had in the past.h34r:


You have no idea how much this has me worried... a sign of the apocalypse??? :rofl:

Just kidding... back to our regularly scheduled discussion about the Trauma "Strip & Flip"


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## Handsome Robb

Bosco578 said:


> Aside from various trauma that requires exposure,cardiac arrest pt's get there shirts/jacket/bra cut.



That's a different situation all together. That's a situation where you need to have access to the chest. If we are in a public place I'm enlisting bystanders or fire to hold blankets up to give us our privacy. Another option is a towel as well. expose them find your landmarks, place your pads and in my case the Philips qCPR puck then drape a small towel over their breasts and continue what we are doing. Our pucks have the screen on them but the monitor still displays the CPR display under the rhythm display so they can use that. The security services here at the casinos have temporary "walls" they bring out when we are working an arrest in a public place on their property. Well they are supposed to bring them out. If they are too lazy to bring them they are getting stuck holding up blankets. Plus I can hang my IV bag from them as well


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## Akulahawk

NVRob said:


> That's a different situation all together. That's a situation where you need to have access to the chest. If we are in a public place I'm enlisting bystanders or fire to hold blankets up to give us our privacy. The security services here at the casinos have temporary "walls" they bring out when we are working an arrest in a public place on their property. Well they are supposed to bring them out. If they are too lazy to bring them they are getting stuck holding up blankets. *Plus I can hang my IV bag from them as well*


I call that the EMT/firefighter/bystander IV pole. They're wonderful!


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## Handsome Robb

Akulahawk said:


> I call that the EMT/firefighter/bystander IV pole. They're wonderful!



Yes they are! I never subject my partner to it though. I need their hands free and generally if you do it to a firefighter here they will find a bystander to pawn it off on. I did have a captain do it for me once though. I rested the bag with the pressure infuser on the top of a dresser then the next time I turned around the captain was holding the bag and standing on a chair. Talk about a great effort! I always feel weird "ordering" around firefighters and coworkers when I'm wearing my spiffy white intern shirt. I've found that please and thank you go a long way. 

The one downside to the bystander IV pole is that it can be a pretty traumatizing experience for the bystander. Especially if they have never seen something like it before. I've noticed in all the codes I have run there is usually one bystander who is overly interested and willing to help. 

Unfortunately in my short career I've run or been a part of more than my fair share of them.


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## Akulahawk

NVRob said:


> Yes they are! I never subject my partner to it though. I need their hands free and generally if you do it to a firefighter here they will find a bystander to pawn it off on. I did have a captain do it for me once though. I rested the bag with the pressure infuser on the top of a dresser then the next time I turned around the captain was holding the bag and standing on a chair. Talk about a great effort! I always feel weird "ordering" around firefighters and coworkers when I'm wearing my spiffy white intern shirt. *I've found that please and thank you go a long way.
> *
> The one downside to the bystander IV pole is that it can be a pretty traumatizing experience for the bystander. Especially if they have never seen something like it before. I've noticed in all the codes I have run there is usually one bystander who is overly interested and willing to help.
> 
> Unfortunately in my short career I've run or been a part of more than my fair share of them.


Indeed it does! The Firefighters I interned with would absolutely bend over backward for me as long as I _asked _them to. This includes Captains, Battalion Chiefs... It is just amazing how willing people are to help you out when you're just nice to them. Never forget the "thank you" because it's just the right thing to do. Eventually even the other Firefighters  at other stations were just as willing to help me out because they'd heard that I wasn't a jerk... Believe me, word got around really fast! It's a very small world in EMS.


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## zmedic

So not say that the bra has to come off in the ambulance, but it's coming off in the trauma room. I need access to that area for:

1: My FAST ultrasound
2: Monitor leads
3: Possible 12 lead

If they are sick there might be the need for:
4: Chest tubes
5: Pericardiocentesis

If they are coming into the trauma room you are saying "they are sick enough that they may need surgery so 

6: Pre-op patients need their bra off. 

I also need to see everything, and see it quick. I need to look between the butt cheeks, everywhere. Probably am putting in a foley. Also i'd point out:

7: If they are damp, the cotton bra/underwear is going to make them colder. 

So like I said, it doesn't have to happen in the rig, but it's happening in the trauma bay. And at least cut the shirt so I can start my IVs and get vitals as soon as they hit the trauma bay. 

Also, move the darn patient to the bed, then start talking. Or do it at the same time. But when the medic sits there talking while 20 people are waiting for the patient to be moved to start treating it makes us a bit nuts.


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## DrParasite

zmedic said:


> Also, move the darn patient to the bed, then start talking. Or do it at the same time. But when the medic sits there talking while 20 people are waiting for the patient to be moved to start treating it makes us a bit nuts.


oddly enough, our trauma attending wanted the exact opposite.  He insisted a report be given by EMS to the trauma team, and only after everyone had no questions, could we transfer the patient to the trauma bed, and they would go to work.  apparently the doctors and nurses wouldn't pay attention to the EMS report if we transferred the patient to the bed and then get a report.

Would drive me nuts, because it delayed our turnaround time, and it delayed my cleaning and stocking time, which kept me in the ER longer that an EMS crew should, especially with calls holding (and no, management frowns on using mutual aid).

I would rather drop the patient off, take the cot and start cleaning and restocking, while my partner gives the report and let the trauma team go to work.  but the trauma MD's don't want it that way, so we did what they said.

As for the OP's question, on a sick/critical trauma patient, everything comes off, and they patient is covered with a sheet.  on a non-sick trauma patient, leave underwear on assuming it doesn't interfere with assessment.  if it interferes, than off it goes.

Also, if they can't take it off themselves, or it hurts too much for them to take it off, and I need it off, than snip snip it goes.  also remember, just because you are helping the patient out by not cutting their clothes in the truck doesn't mean the ER won't snip it all off when they get onto the hospital bed.


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## NomadicMedic

My rule of thumb is this: a "serious" multisystem trauma gets stripped and covered with blankets once I have everything done. We're bringing in patients that are borderline hypothermic... While I need them naked, they don't need to be chilled to the bone.


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## Sasha

NVRob said:


> Yes they are! I never subject my partner to it though. I need their hands free and generally if you do it to a firefighter here they will find a bystander to pawn it off on. I did have a captain do it for me once though. I rested the bag with the pressure infuser on the top of a dresser then the next time I turned around the captain was holding the bag and standing on a chair. Talk about a great effort! I always feel weird "ordering" around firefighters and coworkers when I'm wearing my spiffy white intern shirt. I've found that please and thank you go a long way.
> 
> The one downside to the bystander IV pole is that it can be a pretty traumatizing experience for the bystander. Especially if they have never seen something like it before. I've noticed in all the codes I have run there is usually one bystander who is overly interested and willing to help.
> 
> Unfortunately in my short career I've run or been a part of more than my fair share of them.



I keep getting stuck on with a stretcher with a broken IV pole. My regular partners know what I want when I tell them to "Be tall" and will pick up the bag and hold it up themselves. I've trained them very well >

That being said, "ordering" someone around is wrong. I always ask "Can you please" "will you please" first. If they are being difficult then it goes to "I need you to do this now." "Do this, do that, go get that" etc.


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## EMT John

Akulahawk said:


> If I have to strip a patient, I'm going to do it by however and whatever means necessary. That doesn't mean that I'm going to expose the patient to the world unnecessarily. One snip and a bra opens to expose the full anterior chest. Two more snips and it stays on the gurney... Two snips of the underwear and I can get at the entire pelvis and perineum. That doesn't mean that I'm going to just leave the patient that way. It means that I can flip the fabric back up and cover those parts and provide for modesty as much as possible.
> 
> One trauma patient I had, I'd stripped him down to his underwear. Had I not snipped off that too, and exposed him completely, I would have missed that his scrotum was quite enlarged, full of blood. That event would not have been good...



So would you cut your window blinds down to look outside? Or move it to the side, see if anything is there and move on? Same goes for underwear, can you not just move them to the side and take a look? Bra's are small enough and tight fitting to work around and keep the pt comfortable in a trauma. I think if I go on its going to be beating a dead horse.


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## Handsome Robb

What it comes down to is everyone has their own style of doing things. There's a thousand ways to get from A to B and as long as you are efficient and not causing further harm to the patient it doesn't really matter as long as you get to the end goal.


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## mycrofft

Agreed, and kudos for the Please and Thank You department.

And NOWHERE did I read of anyone slashing off the clothes with their knife, V-blade, etc!


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## shannonlovesth

Anytime I bring a pt. to our Level 1 Trauma center there clothes are getting cut.  Pt. that are unconscious.  Also if your not able to get large hoodies jackets off and impedes me from hearing an accurate blood pressure than i'm will cut the sleeve to get the cuff on.

I have a question though. Can someone explain to me what is the big deal with using Trauma Shears? People in my department always get all excited when they hear someone got to use trauma shears (even if its for something stupid.) for example I was cutting a kravat off of the stretcher once and a crew member saw me do it and shouted "No fair she got to use her shears".


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## medichopeful

shannonlovesth said:


> I have a question though. Can someone explain to me what is the big deal with using Trauma Shears? People in my department always get all excited when they hear someone got to use trauma shears (even if its for something stupid.) for example I was cutting a kravat off of the stretcher once and a crew member saw me do it and shouted "No fair she got to use her shears".



Although using them can be enjoyable, people in EMS are obsessed with equipment and tools (whatever it is).  For many of the people I know who work EMS, it's all "TOYS!!!" not "knowledge," as sad as it is.


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## shannonlovesth

medichopeful said:


> Although using them can be enjoyable, people in EMS are obsessed with equipment and tools (whatever it is).  For many of the people I know who work EMS, it's all "TOYS!!!" not "knowledge," as sad as it is.



Agreed. I sometimes forget that the shears could fall under "Toys". 

Also love the signature quote.


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## medichopeful

shannonlovesth said:


> Agreed. I sometimes forget that the shears could fall under "Toys".
> 
> Also love the signature quote.



Thanks!

Nothing wrong with toys, the problem is when they replace knowledge.


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## the_negro_puppy

In major traumas you need to be fully exposing and examining your patients, particularly if they are unconscious. Its not cold here so major trauma pts generally are transported in their underwear with a sheet.


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## Tigger

shannonlovesth said:


> Anytime I bring a pt. to our Level 1 Trauma center there clothes are getting cut.  Pt. that are unconscious.  Also if your not able to get large hoodies jackets off and impedes me from hearing an accurate blood pressure than i'm will cut the sleeve to get the cuff on.
> 
> I have a question though. Can someone explain to me what is the big deal with using Trauma Shears? People in my department always get all excited when they hear someone got to use trauma shears (even if its for something stupid.) for example I was cutting a kravat off of the stretcher once and a crew member saw me do it and shouted "No fair she got to use her shears".



There are many in EMS that are still wondering why the job is different than what they thought they were getting themselves into. Too many people think EMS is all about grievous traumas and everyone is sick or hurt enough to have their clothes cut off so the EMT can provide that life saving treatment. Unfortunately there are not enough people attempting to quash this expectation by any means necessary.


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## flhtci01

NVRob said:


> When they can't take them off for themselves. I always tell them "I need your shirt off" and if they refuse or can't help me get it off of them snip snip snip.



I have found they are usually very cooperative when I ask them "Would you like to take it off or have it cut off?  They like to cut things off in the ER."  

It's amazing how cooperative they are taking off hoodies and pullovers when they have a fractured arm or clavicle.


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## Tigger

Also if I might add that if the patient is conscious maybe ask them before cutting of their clothes? Many people are willing to cooperate with you if you just ask, even if it means they're putting themselves in some discomfort. I'd rather suffer for a minute than have to suffer watching someone cut off my favorite (and not cheap) ski jacket or something like that.


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## emt-slick

emt.dan said:


> When it's necessary for you to inspect or palpate an area of the body not otherwise accessible, or not easily accessible without exacerbating said injury. Unresponsive multi-trauma victim may be an example...
> 
> With all of that said, one rule. Never cut down-material. Ever.




Hahaha I made that mistake once, the truck looked like we sacrificed a chicken


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## beefaroni

EMT John said:


> All which can be done with underwear on. One snip bra comes off and there's your chest tube and X-ray. People don't need to be paraded around like some kind of show. Dignity is going to lessen stress and provide trust/repor with my pt  which in the long run helps the pt. I don't need to continuously stare at someones goodies. I can palpate a chest through a bra and check a pelvice through some chones.




The trauma room cannot do that "special" finger sweep with the pt underwear on..  Sorry..  Put a sheet over them as they come in through the er..


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## ZootownMedic

I dont care if they are conscious or not. If it is a trauma with any serious mechanism the clothes are coming off. Are you guys spinaling these patients? You need their clothes off but your not spinaling them? Doesn't make sense. The patients whose clothes come off for me are patients who are having c-spine held, and being spinally immobilized. That means they aren't moving(ie taking their own clothes off) whether they are conscious or not. I am not a veteran of the streets by any means but this is how I do it. There are exceptions of course but if need to examine them from head to toe it means HEAD to TOE.


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## WestMetroMedic

Sorry to join the game late...

Where do all of these down coats exist?  I live in Minnesota (and have worked 5 winters for a cold weather camping program for the boy scouts), which is, by common definition, rather cold in the winter, sometimes the summer too, and i don't know anyone who owns a down parka, nor have i ever encountered a trauma patient wearing one of these fabled coats.  Perhaps it is all of you southerners who cannot tolerate a "frigid" 45 degree day (after a long winter, that is shorts and t shirt weather).  I did however realize, that i own a down sleeping bag and a couple duck down pillows, they are wonderful.

Next up, a blanket or Bair hugger in the back of an ambulance does wonders.  Lose all of the clothes for someone who is a red patient, but if we can take them of the old fashioned way, that's cool, but clothes are wet and they get in the way, and you probably have timed to do out on the way to the doctor place.  If i cut then off and i for some reason decide the archaic backboard needs to be used, i have found amazing results with citing up the back off their shirt when you have them log rolled over.  Much easier than cutting up the front and down each arm.


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## Tigger

SmokeMedic said:


> I dont care if they are conscious or not. If it is a trauma with any serious mechanism the clothes are coming off. Are you guys spinaling these patients? You need their clothes off but your not spinaling them? Doesn't make sense. The patients whose clothes come off for me are patients who are having c-spine held, and being spinally immobilized. That means they aren't moving(ie taking their own clothes off) whether they are conscious or not. I am not a veteran of the streets by any means but this is how I do it. There are exceptions of course but if need to examine them from head to toe it means HEAD to TOE.



The first part is no good here. If you're using MOI to determine who gets their clothes cut off, issues may arise. If the patient is concious, ask them to help. I hit a tree skiing six months ago going fast. No one cut off my clothes despite me being on a board. They asked first, and I helped them remove my ski stuff. Cut my jacket off and you just cost my 400 dollars when I could have done it myself.


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## Handsome Robb

Tigger said:


> Cut my jacket off and you just cost my 400 dollars when I could have done it myself.





			
				WestMetroMedic said:
			
		

> Where do all of these down coats exist?



I was a pro ski patroller so I had to deal with down coats all the damn time.


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## emt-slick

Boston area, anyone wearing a puffy winter coat it is usually filled with down or some other sort of fluff


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## Deuce

Here in Santa Clara they tell us Pretty much never to cut clothes unless its a major trauma


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## phideux

shannonlovesth said:


> Anytime I bring a pt. to our Level 1 Trauma center there clothes are getting cut.  Pt. that are unconscious.  Also if your not able to get large hoodies jackets off and impedes me from hearing an accurate blood pressure than i'm will cut the sleeve to get the cuff on.
> 
> I have a question though. Can someone explain to me what is the big deal with using Trauma Shears? People in my department always get all excited when they hear someone got to use trauma shears (even if its for something stupid.) for example I was cutting a kravat off of the stretcher once and a crew member saw me do it and shouted "No fair she got to use her shears".



Benchmade rescue hook beats the hell out of trauma shears.


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## bahnrokt

I learned that you never cut a bikers leathers without premission.  The guy dumped his bike and chewed his left arm up pretty good between the road and the bike.  Since the leather was torn from the crash I didnt even think twice about cutting. Cutting his leathers was meet with the same reaction as a surprise circumcision.


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## Bluegrass

Whatever you don't strip in the field, we have to strip in the ER.  
If its serious.... Go full Monty!


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## Bullets

WestMetroMedic said:


> Sorry to join the game late...
> 
> Where do all of these down coats exist?  I live in Minnesota (and have worked 5 winters for a cold weather camping program for the boy scouts), which is, by common definition, rather cold in the winter, sometimes the summer too, and i don't know anyone who owns a down parka, nor have i ever encountered a trauma patient wearing one of these fabled coats.  Perhaps it is all of you southerners who cannot tolerate a "frigid" 45 degree day (after a long winter, that is shorts and t shirt weather).  I did however realize, that i own a down sleeping bag and a couple duck down pillows, they are wonderful.
> 
> Next up, a blanket or Bair hugger in the back of an ambulance does wonders.  Lose all of the clothes for someone who is a red patient, but if we can take them of the old fashioned way, that's cool, but clothes are wet and they get in the way, and you probably have timed to do out on the way to the doctor place.  If i cut then off and i for some reason decide the archaic backboard needs to be used, i have found amazing results with citing up the back off their shirt when you have them log rolled over.  Much easier than cutting up the front and down each arm.



Spend some more time in urban areas in the northeast. Big puffy coats are a fashion statement, hip hop culture and all that jazz

I deal with them all the time, but its never feathers, its usually some synthetic stuffing


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## AnthonyM83

SmokeMedic said:


> I dont care if they are conscious or not. If it is a trauma with any serious mechanism the clothes are coming off. Are you guys spinaling these patients? You need their clothes off but your not spinaling them? Doesn't make sense. The patients whose clothes come off for me are patients who are having c-spine held, and being spinally immobilized. That means they aren't moving(ie taking their own clothes off) whether they are conscious or not. I am not a veteran of the streets by any means but this is how I do it. There are exceptions of course but if need to examine them from head to toe it means HEAD to TOE.



One big cut the clothes, but no cspine exception would be stabbings....
but yes, generally if it's multi-system trauma or if we're looking for injuries, then it usually tends to be a patient who doesn't meet the criteria for being "cleared"...


----------



## VirginiaEMT

I a very rural,, mountainess area not far from me, a medic was on the scene of a wreck which are almost always bad in that area, and he cut the clothes of of the patient to do his assessment. The patient signed a refusal to be transported and they actually had to tape his clothes back together for him to get home.



AnthonyM83 said:


> One big cut the clothes, but no cspine exception would be stabbings....
> but yes, generally if it's multi-system trauma or if we're looking for injuries, then it usually tends to be a patient who doesn't meet the criteria for being "cleared"...


----------



## CodeBru1984

phideux said:


> Benchmade rescue hook beats the hell out of trauma shears.



+1. I need to get one of these! While I think trauma shears are good, the Benchmade rescue hook hands down is much better.


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## paramedicjon

*Me*

I vote cut baby, they arent my clothes.


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## Nathan

Depends on the situation, I doubt anyone would really question your judgement unless Megan Foxx is in the back of your ambulance naked complaining of a sore throat. Situation dictates.


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## shiroun

Nathan said:


> Depends on the situation, I doubt anyone would really question your judgement unless Megan Foxx is in the back of your ambulance naked complaining of a sore throat. Situation dictates.




Well hey, some people got into EMS for saving lives. Personally I got in for the expose and palpate :rofl:


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## PVC

If patient advocacy is king then I am contentious that on occasions it may be the patient's only pair of pants or only shirt. I try to not perform unnecessary procedures, including cutting away clothes. 

That said if i have to see it and clothes are in the way I never hesitate to cut.
I do keep a bag of old clothes in my truck to replace the ones I cut away among the homeless.
A perfect fit is not that important to them.


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## NomadicMedic

I've also taped pants back together after cutting. A ped struck by a car. Guy refused after I shredded his pants. 

Not one of my prouder moments.


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## EMT1A

Wouldn't you have to cut away the clothes surrounding the chest to perform proper cpr anyways?


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## NomadicMedic

EMT1A said:


> Wouldn't you have to cut away the clothes surrounding the chest to perform proper cpr anyways?



One would think, but a past debate here showed that many don't believe baring the chest is necessary for CPR. :/


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## Asclepius911

Yes, out with the shirt worst case scenario in CPR is defib,  don't wait till then to cut of his/her clothing, plus it would be cool to use the trama shears for its intended purpose instead of using it to cut tape


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## leoemt

OP, you seem to be asking the same questions over and over. Here is one of your thread's from EMTcity where you are asking essentially the same question: http://www.emtcity.com/topic/22063-...onsive-patients/page__hl__ when  cut  clothes

Additionally, sometimes you represent yourself as a medically trained professional, others as a lay person. Which is it? Are you a legitimate medical professional or are you a wannabe?

It is the goal of forums such as EMTlife and others to help educate people, and to pass ideas back and forth. It is not my position to judge you nor to have anyone else judge you. I sincerely hope for your sake that you are using this information to supplement knowledge obtained in an accredited First Responder or EMT class, and that you are not acting as a "ricky rescue". A first aid class does not make you First Responder Trained.

As for exposing someone, its a judgement call. Exposing someone does not always mean to cut clothes. You can expose by lifting clothes or by physically undressing them if necessaray. If time permits and you need to cut the clothes, try cutting down the seams - that way a seamstress can repair the clothes. 

Its life over property though and if patient is critical then the shears come out and the clothes are being cut away. Clothes are replacable. 

You will always expose to an extent. It may be as simple as lifting a shirt to place your stethoscope for lung sounds or you may be cutting clothes off. 

This is the third thread that I know of that you started about this topic on two separate boards. I hope after the several dozen responses you have received that you are starting to get the clue that EMS is not black and white. Its a judgement call based on how sick the patient is.


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## Achilles

leoemt said:


> OP, you seem to be asking the same questions over and over. Here is one of your thread's from EMTcity where you are asking essentially the same question: http://www.emtcity.com/topic/22063-...onsive-patients/page__hl__ when  cut  clothes
> 
> Additionally, sometimes you represent yourself as a medically trained professional, others as a lay person. Which is it? Are you a legitimate medical professional or are you a wannabe?
> 
> It is the goal of forums such as EMTlife and others to help educate people, and to pass ideas back and forth. It is not my position to judge you nor to have anyone else judge you. I sincerely hope for your sake that you are using this information to supplement knowledge obtained in an accredited First Responder or EMT class, and that you are not acting as a "ricky rescue". A first aid class does not make you First Responder Trained.
> 
> As for exposing someone, its a judgement call. Exposing someone does not always mean to cut clothes. You can expose by lifting clothes or by physically undressing them if necessaray. If time permits and you need to cut the clothes, try cutting down the seams - that way a seamstress can repair the clothes.
> 
> Its life over property though and if patient is critical then the shears come out and the clothes are being cut away. Clothes are replacable.
> 
> You will always expose to an extent. It may be as simple as lifting a shirt to place your stethoscope for lung sounds or you may be cutting clothes off.
> 
> This is the third thread that I know of that you started about this topic on two separate boards. I hope after the several dozen responses you have received that you are starting to get the clue that EMS is not black and white. Its a judgement call based on how sick the patient is.



Actually in some other thread I don't even recall it, he said that all of the scenarios were made up. I believe he also said he was kicked out of his MFR class. And I also believe he said he was never going to come back here again. Which is fine but he will lose valuable info on good subjects.


----------



## jim10036

*A patient's view on an old post, but relevant topic*

I recently had a crash on my bike...it involved a car but everything was fine, except I suspected my hand was broken; it didn't hurt, it was just really swollen...the EMT responded and I debated going to the hospital in the ambulance for the very topic of this post...but decided to....

When I arrived in the ED I was alert, awake, and rational....the EMT had unzipped my jersey but had left my bibs on....two nurses came in and tried to start cutting off my bike clothes....I stopped them....then they said I needed to remove my clothing, almost demanding it, no almost about it, they did demand...I refused...the only thing wrong was my hand...no long bones broken, no back pain, etc.  

They got really bent out of shape...they called the attending resident in and he also "demanded" that I remove my clothing....I refused...He did the exam palpated my abdomen, felt my bones and pelvis to make sure nothing was broken but he was not happy....Really, what difference is it to you guys....expose what you need to expose...leave the rest alone unless the patient gives you permission...patients have the right to refuse to disrobe....and this situation did not create an exception, i.e., there was not an extreme likelihood of immediate serious harm to myself or others....I was concious and could make informed decisions for myself...

patients have rights, long gone are the days where physicians have unfettered control or say in patient treatment...it is out body and we have the final say in our treatment and what happens to us....I will try to say this nicely, but in my experience everything that is done is done for the physican's convenience...with most not caring about the patient's wishes....its more convenient for the physican, the doctor prefers it, doctors don't like working about a patients clothes...etc....it was encouraging to see some of your comments supporting our rights

I was looking for a post on this topic to voice my opinion after my experience...maybe vent a little...btw, it was only my hand that was broken...


----------



## VFlutter

jim10036 said:


> patients have rights, long gone are the days where physicians have unfettered control or say in patient treatment...it is out body and we have the final say in our treatment and what happens to us....I will try to say this nicely, but in my experience everything that is done is done for the physican's convenience...with most not caring about the patient's wishes....its more convenient for the physican, the doctor prefers it, doctors don't like working about a patients clothes...etc....it was encouraging to see some of your comments supporting our rights



We live in a very litigious society and many Physicians are not willing to take the chance by preforming a sub-standard exam. For any patient coming in for "Trauma" there is a very detailed whole body exam, including a rectal exam, that they perform. 

Even if you were only complaining of hand pain and refused to undress you could have potentially still had a serious injury elsewhere on your body. And many people would be happy to sue the Physician for "missing" an injury. 

That being said, you as the patient have the right to refuse any part of treatment that you do not want. But by doing so you must understand you are potentially placing yourself at a higher risk or may not receive the best possible care.


----------



## Carlos Danger

jim10036 said:


> They got really bent out of shape...they called the attending resident in and he also "demanded" that I remove my clothing....I refused...He did the exam palpated my abdomen, felt my bones and pelvis to make sure nothing was broken but he was not happy....Really, what difference is it to you guys....expose what you need to expose...leave the rest alone unless the patient gives you permission...patients have the right to refuse to disrobe....and this situation did not create an exception, i.e., there was not an extreme likelihood of immediate serious harm to myself or others....I was concious and could make informed decisions for myself...
> 
> patients have rights, long gone are the days where physicians have unfettered control or say in patient treatment...it is out body and we have the final say in our treatment and what happens to us....I will try to say this nicely, but *in my experience everything that is done is done for the physican's convenience...with most not caring about the patient's wishes....its more convenient for the physican, the doctor prefers it, doctors don't like working about a patients clothes...etc*....it was encouraging to see some of your comments supporting our rights
> 
> I was looking for a post on this topic to voice my opinion after my experience...maybe vent a little...btw, it was only my hand that was broken...



I think there is definitely something to the larger issue that you touch on here about physician paternalism, but it is really beside the point here because clothes aren't removed from trauma patients "just for the convenience" of anyone. Inspection of the entire body is a standard of care and there is good reason for it. People have injuries all the time that they aren't aware of until someone visualizes or palpates it, and sometimes they are serious. Ronald Reagan was shot in the chest and didn't know it until his lung collapsed. 

That said, if a patient refuses having their clothes removed (or anything else) and some firm but gentle and respectful explanation of the necessity and importance doesn't change their mind, then the nurses and doctors should simply document the refusal and continue with the rest of what they need to do. Certainly there is never a justification for treating a patient badly over it.


----------



## JPINFV

jim10036 said:


> When I arrived in the ED I was alert, awake, and rational....the EMT had unzipped my jersey but had left my bibs on....two nurses came in and tried to start cutting off my bike clothes....I stopped them....then they said I needed to remove my clothing, almost demanding it, no almost about it, they did demand...I refused...the only thing wrong was my hand...no long bones broken, no back pain, etc.
> 
> They got really bent out of shape...they called the attending resident in and he also "demanded" that I remove my clothing....I refused...He did the exam palpated my abdomen, felt my bones and pelvis to make sure nothing was broken but he was not happy....Really, what difference is it to you guys....expose what you need to expose...leave the rest alone unless the patient gives you permission...patients have the right to refuse to disrobe....and this situation did not create an exception, i.e., there was not an extreme likelihood of immediate serious harm to myself or others....I was concious and could make informed decisions for myself...



The trauma exam is a very standardized exam that checks everything. Trust me when I say the following that I am no very prone to hyperbole. Yes, unless someone looks, you can always miss an injury. Yes, looking and feeling is always better than feeling alone. Yes, you have a right to refuse, but we have the right to no be thrilled when you do.


----------



## jim10036

JPINFV said:


> Yes, you have a right to refuse, but we have the right to no be thrilled when you do.



I would think you would be thrilled when someone refused (its less work for you and frankly, I cant imagine most of the people who come through the ED are pretty to look at - I know I would not want to see the people who were working in the ED naked...well, at least no one so far) and I could not understand all of the attitude...note the refusal and move on...but that still doesn't answer my question on why they would even think it was necessary to try and cut it off or even allow me to remove it myself given the injury I was reporting with, even if the standard of care is a full examination....why can't clothing be lowered or moved for the examination if it is appropriate, as it would have been in my case but that was never an option given to me (frankly, race kits don't leave a lot to the imagination anyway).


----------



## chaz90

You're looking at this the wrong way. We worry about missing something. We worry about the patient leaving the ED with an unrecognized injury and having a poor outcome. These things weigh heavily on our professional reputation and on our conscience. Believe me, you're not doing healthcare providers any favors by refusing to disrobe since "nobody wants to see you naked." We certainly don't look at it as observation for any kind of personal pleasure, and neither should you. If damage to your clothing is what you were concerned about, why not take them off yourself? You were obviously conscious, and as mentioned earlier, most of us will never cut clothing off if the patient is conscious and able to comfortably remove it themselves. It is a reasonable expectation that when you seek evaluation at a healthcare facility for potential multisystem trauma they will need to fully examine you.


----------



## jim10036

Chase said:


> We live in a very litigious society and many Physicians are not willing to take the chance by preforming a sub-standard exam. For any patient coming in for "Trauma" there is a very detailed whole body exam, including a rectal exam, that they perform.
> 
> Even if you were only complaining of hand pain and refused to undress you could have potentially still had a serious injury elsewhere on your body. And many people would be happy to sue the Physician for "missing" an injury.
> 
> That being said, you as the patient have the right to refuse any part of treatment that you do not want. But by doing so you must understand you are potentially placing yourself at a higher risk or may not receive the best possible care.



I understand, again, my main issue was with the automatic cutting off of or removing of the clothing.  why could it not just be moved and those areas inspected.  I dont think a rectal exam requires someone to be completely unclothed.  Every case that comes in doesn't need to be treated like a Level 1 trama even if the standard of care is a full body examanition....that can be accomplished by moving clothing as necessary if the situation allows it, which mine would have...On the litigious society issue, I agree, its sad; but frankly, the physician probably put himself in a worse situation legally by not offering to do those parts of the exam with my bibs on and just lowering them for the inspection as necessary....which was never offered, but that probably would have been inconvenient for him.


----------



## jim10036

chaz90 said:


> Believe me, you're not doing healthcare providers any favors by refusing to disrobe since "nobody wants to see you naked." We certainly don't look at it as observation for any kind of personal pleasure, and neither should you.



I don't and never accused anyone of that...I did respond to a post that said they would be thrilled if we refused...which I thought was a little flippiant and responded in kind.  Remember, I was in a bike race kit, I wasn't in a pair of jeans and sweatshirt, 95% of me was unclothed...and the 5% wasn't covered by much....why did it have to come off???  why could it not be shifted and moved to do the examination??  since when does a rectal exam require that a patient be completely unclothed? Frankly, it would have been reasonable under the circumstances for the physican to say sure, we can leave them on but we will have to pull them down to check this or that...but that was never offered; and frankly, I was so put off by the whole situation I would not have agreed to it anyway at that point (even if I thought it was necessary, which I did not, but that is another topic).


----------



## jim10036

chaz90 said:


> It is a reasonable expectation that when you seek evaluation at a healthcare facility for potential multisystem trauma they will need to fully examine you.


  If the patient does not want to remove his/her clothing then why, as professionals interested in our well being, would you not try to accommodate that reasonable request.....the examination in my case could have been done with shifting my clothing...what difference is it, in a case like mine, if you have to pull shorts down to examine the behind and do a rectal exam?  None!


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## chaz90

I'm including the entire exam, not just rectal tone. I also never said we wouldn't accommodate a patient's request, just that it could prove to be a detriment to the care and is certainly not preferred. Look, I'm not in any position to tell you what you can do. If you refuse, that's your business. I am telling you a comprehensive, proper trauma exam is exceedingly difficult when the patient insists on wearing clothes. I won't continue to argue about this. Keep whatever opinion you need, but don't be surprised if you come to an EMS forum to "rant" and are told something other than you want to hear.


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## JPINFV

jim10036 said:


> I would think you would be thrilled when someone refused (its less work for you and frankly,


Less work, more liability, and not really that much less work. There's more time spent trying to convince the patient that a full exam is necessary than the time it would take to actually do a proper trauma exam. Especially one where, based off of the description, the trauma team would be alerted and standing by for. 


> I cant imagine most of the people who come through the ED are pretty to look at - I know I would not want to see the people who were working in the ED naked...well, at least no one so far)


I do my job. My job doesn't depend on what a person looks like. Furthermore, there's no such thing as "hot" when it comes to a patient on a gurney. Actually, to be honest, when it comes to examining a patient the concept of judging their looks doesn't even cross my mind, regardless of what I have to examine. 



> and I could not understand all of the attitude...note the refusal and move on...


You don't allow us to do a complete exam, we "miss" something, you sue. You, individually, might sue, but if you spin a roulette wheel enough times a zero pops up. We'd rather not spin the wheel at all. 



> but that still doesn't answer my question on why they would even think it was necessary to try and cut it off or even allow me to remove it myself given the injury I was reporting with, even if the standard of care is a full examination....why can't clothing be lowered or moved for the examination if it is appropriate, as it would have been in my case but that was never an option given to me (frankly, race kits don't leave a lot to the imagination anyway).



It's not the injury we know about that concerns us. It's the injury we don't know about. 

As far as removing vs cutting, I honestly don't know as I wasn't there. There have been patients where we simply removed the pants, and there are patients where we've cut the pants off. Without hearing what the trauma team heard, I honestly can't comment on the specifics.


----------



## jim10036

thanks to everyone who responded....although you did not change my opinion, I really appreciate you taking the time to respond and share your thoughts on my question....please don't take this the wrong way, but I HOPE I never have need of EMT responders or have to go to the ED again.  thanks again


----------



## JPINFV

jim10036 said:


> I don't and never accused anyone of that...I did respond to a post that* said they would be thrilled if we refused...*which I thought was a little flippiant and responded in kind.




No, I said, "Yes, you have a right to refuse, but we have the right to no be thrilled when you do."

Now, it should have said "no_*t*_ be thrilled," however the negative "no" still results in the same sentiment that we'd rather you comply, just as a grammatical disaster of a sentence.


Edit: The rectal examination is looking for sensation, tone, and gross blood. It's archaic and current evidence shows that it really doesn't add much to the exam, but it's still the standard of care. During a trauma resuscitation exam, it's generally done at the same time we're rolling you and checking your back for injuries, pain, and deformities as well as removing the backboard. You're already rolled, so it's the easiest time to do it.


----------



## Jim37F

When it comes to foot ware, would you just cut the laces? I have a pair of 10" Corcoran Jump Boots, and they can be tough to pull off that I'll usually just remove the laces to take them off. So if you had to remove boots, would you cut the laces or try to cut through the leather?


----------



## JPINFV

Jim37F said:


> When it comes to foot ware, would you just cut the laces? I have a pair of 10" Corcoran Jump Boots, and they can be tough to pull off that I'll usually just remove the laces to take them off. So if you had to remove boots, would you cut the laces or try to cut through the leather?


What ever is the easiest and least destructive way. If we had to remove them, we would probably start with cutting the laces. We don't destroy clothing simply because we can.


----------



## zmedic

I get pissed when my patients aren't undressed because it wastes my time. You are here for a foot problem? If I have to stand there while you take your shoes and socks off it slows me down. Rectal bleeding? People look at me like I'm crazy when I say I have to take a look.


----------



## Tigger

I have no idea why so many people get offended when the ED asks them to put on a johnny. It just isn't a big deal, and while everyone should be respectful of the patient's wishes, it cannot be avoided that the providers frankly know more about their own job than the patient does. Chances are, if a provider makes a request of you, it's in your own best interest however remote. If you don't want to do it fine, but don't get huffy with the staff over it.


----------



## usmc06emt

JPINFV said:


> What ever is the easiest and least destructive way. If we had to remove them, we would probably start with cutting the laces. We don't destroy clothing simply because we can.



I always lace all my shoes to be ems friendly trick learned in USMC flight line class toe side is over and all back are under along sides (that way there is always space under for scissors are a blade if they ever need expedious removal


----------



## the_negro_puppy

When they are hot :wub:


----------



## JPINFV

zmedic said:


> I get pissed when my patients aren't undressed because it wastes my time. You are here for a foot problem? If I have to stand there while you take your shoes and socks off it slows me down. Rectal bleeding? People look at me like I'm crazy when I say I have to take a look.



This is my favorite from about a week ago. 

You're an alcoholic with abdominal pain and your hemoglobin dropped 4 points in 4 months. Yes... I've gotta do a rectal exam. No, I'm not looking forward to it, but yes... we need to rule out a GI bleed. Especially when you say yes when I ask if your stool has been black and tarry.


----------



## Handsome Robb

jim10036 said:


> I don't and never accused anyone of that...I did respond to a post that said they would be thrilled if we refused...which I thought was a little flippiant and responded in kind.  Remember, I was in a bike race kit, I wasn't in a pair of jeans and sweatshirt, 95% of me was unclothed...and the 5% wasn't covered by much....why did it have to come off???  why could it not be shifted and moved to do the examination??  since when does a rectal exam require that a patient be completely unclothed? Frankly, it would have been reasonable under the circumstances for the physican to say sure, we can leave them on but we will have to pull them down to check this or that...but that was never offered; and frankly, I was so put off by the whole situation I would not have agreed to it anyway at that point (even if I thought it was necessary, which I did not, but that is another topic).



How were you in a race suit and 95% uncovered? What were they trying to cut off of you?

Don't take this the wrong way but it sounds like you're self conscious. From your description the ER staff didn't approach the situation the right way but there are other variables to it. How did you approach them? If someone is being difficult I'm not nice, I always start out nice but if I get pushed I wont stay that way and I know I'm not the only one. I'm not saying you were difficult but your story doesn't make sense. How fast were you going? all you said was an accident on a motorcycle involving a car. That leaves things wide open. While mechanism of injury is a poor indicator of seriousness of injuries motorcycle accidents aren't taken lightly. It's been beaten to death, the injury that we don't know about yet is the scary one.


----------



## DesertMedic66

Robb said:


> How were you in a race suit and 95% uncovered? What were they trying to cut off of you?



I was thinking that too. Race suits tend to cover your whole body. Why would you be riding a bike with less than 5% of your body covered? 5% is pretty much a thong + shoes + gloves and nothing else.....

EDIT: After going back through the older posts I think the poster was stating he was 95% uncovered after the responding EMTs took his jersey off.


----------



## Akulahawk

He's a bicyclist... he doesn't wear motorcycle racing leathers.


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## JPINFV

Akulahawk said:


> He's a bicyclist... he doesn't wear motorcycle racing leathers.




Doesn't change much without more info to be honest. Motorcycle v car? Bicycle v car? Depending on the entire situation can be anywhere from dropped off at any ED to having an O on standby on arrival.


----------



## Akulahawk

JPINFV said:


> Doesn't change much without more info to be honest. Motorcycle v car? Bicycle v car? Depending on the entire situation can be anywhere from dropped off at any ED to having an O on standby on arrival.


The comment was how he was wearing so little clothing while riding a bike. I think some here were thinking motorcycle and not bicycle.


----------



## Achilles

Tigger said:


> I have no idea why so many people get offended when the ED asks them to put on a johnny. It just isn't a big deal, and while everyone should be respectful of the patient's wishes, it cannot be avoided that the providers frankly know more about their own job than the patient does. Chances are, if a provider makes a request of you, it's in your own best interest however remote. If you don't want to do it fine, but don't get huffy with the staff over it.



It seems the people that are in relatively the same career; EMS, Nursing, DO/MD or other healthcare position, can be the worst. I don't let it get to me though. 

As for cutting clothes, I'll try to cut down the seam so you can sew it later on.


----------



## jim10036

Tigger said:


> I have no idea why so many people get offended when the ED asks them to put on a johnny. It just isn't a big deal, and while everyone should be respectful of the patient's wishes, it cannot be avoided that the providers frankly know more about their own job than the patient does. Chances are, if a provider makes a request of you, it's in your own best interest however remote. If you don't want to do it fine, but don't get huffy with the staff over it.



Yes, you have a different skill set than most of those reporting in the ED.  

And it was not, "take these off and put on this gown", the nurse came in and said Im going to have to cut this off of you...I hope you can imagine my surprise to this when I reported to the ED with only a broken hand.....and I did not get huffy until they got huffy....frankly, after doing research on line I discovered that states have had to enact patient's bills of rights...giving patients the right, among other things, to refuse treatment, and to refuse to disrobe.  What is wrong with our medical care providers when law makers have had to go to such measures to protect patient's rights.  No means no! 

Mine was not a life or limb threatening case and to be treated as such was a huge waste of time, and frankly resources and money. 
If I had needed a full exam I would not have had a problem with it...I still would have wanted to take off my bibs rather than having them cut off, but if I am in a condition where it is necessary to cut them off, cut away, I might not like it but my bibs are replaceable.  My issue here was that it was NOT necessary with what I was presenting with.


----------



## jim10036

Robb said:


> How were you in a race suit and 95% uncovered? What were they trying to cut off of you?
> 
> Don't take this the wrong way but it sounds like you're self conscious. From your description the ER staff didn't approach the situation the right way but there are other variables to it. How did you approach them? If someone is being difficult I'm not nice, I always start out nice but if I get pushed I wont stay that way and I know I'm not the only one. I'm not saying you were difficult but your story doesn't make sense. How fast were you going? all you said was an accident on a motorcycle involving a car. That leaves things wide open. While mechanism of injury is a poor indicator of seriousness of injuries motorcycle accidents aren't taken lightly. It's been beaten to death, the injury that we don't know about yet is the scary one.



I am a cyclist (bike)...we wear shorts (bibs) with a jersey over them...they are very thin and light.....I had already unzipped my jersey so I really was only in my bib shorts....

I started out nice, and simply told the nurse no, she was not cutting off my bibs....it went down hill from there.


----------



## jim10036

zmedic said:


> I get pissed when my patients aren't undressed because it wastes my time. You are here for a foot problem? If I have to stand there while you take your shoes and socks off it slows me down. Rectal bleeding? People look at me like I'm crazy when I say I have to take a look.



If I report with rectal bleeding you bet you are looking down there, but if I report with a broken hand, nope.


----------



## jim10036

As far as removing vs cutting, I honestly don't know as I wasn't there. There have been patients where we simply removed the pants, and there are patients where we've cut the pants off. Without hearing what the trauma team heard, I honestly can't comment on the specifics.[/QUOTE]

If I could have ridden my bike to the hospital I would have....but the front wheel was cracked....I don't know what they heard but it was probably something along the lines of male reporting with broken hand, conscious, alert, standing and walking on arrival with no other complaint, pain or injury. The paramedics were not insisting that I go to the hospital, we talked and discussed it for a while, they cleaned up the road rash while I talked with the police who had responded, but in the end, I decided it would be better to get my hand looked at right away...


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## Achilles

> If I could have ridden my bike to the hospital I would have....but the front wheel was cracked....I don't know what they heard but it was probably something along the lines of male reporting with broken hand, conscious, alert, standing and walking on arrival with no other complaint, pain or injury. The paramedics were not insisting that I go to the hospital, we talked and discussed it for a while, they cleaned up the road rash while I talked with the police who had responded, but in the end, I decided it would be better to get my hand looked at right away...



And part of looking at your hand included an trauma assessment. (you need to see the extremities to do this as well as the abdomen, and the back.)


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## jim10036

Achilles said:


> And part of looking at your hand included an trauma assessment. (you need to see the extremities to do this as well as the abdomen, and the back.)



Maybe, but the original issue was why was it necessary to try to cut off my clothing...why, given the circumstances could the trauma assessment not have been done with my clothing on....little as it was.   Why could they have just agreed and said, sure but we will have to move it to check this or that....Someone accused me of having modesty issues, maybe I do, but no one wants to be stripped lying naked on a table when their complaint is a broken hand...when it needs to be done, it needs to be done, but this was not a situation in my opinion that warranted it....and fortunately, I have the final say. No means no....and and as soon as I said no their attitude changed....mine changed to match theirs.


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## NomadicMedic

I think the point has been made. You didn't want your clothes cut off, the ED staff did. You both disagreed, treatment was rendered, you went home. 

Lets move on.


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## Brandon O

No clothing is allowed in my ambulance. Patients or providers.

Observers may wear a small fig leaf, but only one. Front or back, dealer's choice.


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## JPINFV

jim10036 said:


> frankly, after doing research on line I discovered that states have had to enact patient's bills of rights...giving patients the right, among other things, to refuse treatment, and to refuse to disrobe.  What is wrong with our medical care providers when law makers have had to go to such measures to protect patient's rights.  No means no!


Short of being mandated to accept treatment due to being incompetent due to psychatric illness, a competent patient can refuse anything. There's nothing new or magical or special about that. However, again, the medical and nursing staff will push for what we think is in your best interest. You can lead a horse to water, but you can't make him drink. 



> My issue here was that it was NOT necessary with what I was presenting with.


You were presenting as a bicycle vs car. The bicycle normally loses that encounter, and normally loses hard.


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## Akulahawk

JPINFV said:


> Short of being mandated to accept treatment due to being incompetent due to psychatric illness, a competent patient can refuse anything. There's nothing new or magical or special about that. However, again, the medical and nursing staff will push for what we think is in your best interest. You can lead a horse to water, but you can't make him drink.
> 
> 
> You were presenting as a bicycle vs car.* The bicycle normally loses that encounter, and normally loses hard.*


That's putting it mildly. One of the more interesting calls I'd ever had involved that very same MOI. Patient was thrown into a very soft dirt berm. The bicycle was still upright. Straight upright. It's front wheel was buried in that berm. The rear wheel resembled a taco... Aside from being a bit angry about being hit by a car, being a bit dusty on the back, and having to replace the wheel, the rider was completely uninjured. Not even so much as a bit of road rash. 

There was a GREAT outline of the patient's body in the dirt berm after we got him up and out of it. We could even see seams and shirt wrinkles!


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## Handsome Robb

Akulahawk said:


> He's a bicyclist... he doesn't wear motorcycle racing leathers.



That clears things up. Still was covered more than 5% even without a jersey on. 

Sure we can move loose clothes out of the way, tight spandex? Definitely not. 

The more I read and think the more it seems like you might have had an attitude and got attitude in return. 

We don't do things for no reason. Alright, sometimes we do but exposing a patient, especially in an injury with a high mechanism, is not one of them.


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## Handsome Robb

jim10036 said:


> Maybe, but the original issue was why was it necessary to try to cut off my clothing...why, given the circumstances could the trauma assessment not have been done with my clothing on....little as it was.   Why could they have just agreed and said, sure but we will have to move it to check this or that....Someone accused me of having modesty issues, maybe I do, but no one wants to be stripped lying naked on a table when their complaint is a broken hand...when it needs to be done, it needs to be done, but this was not a situation in my opinion that warranted it....and fortunately, I have the final say. No means no....and and as soon as I said no their attitude changed....mine changed to match theirs.



Because clothing hides things. See my post above this one about loose clothing versus tight clothing. 

I don't understand what you don't understand about this. We live in a sue happy society. How do we know that if you refuse to disrobe or allow us to disrobe you so we can do a proper assessment and you end up having an undiscovered injury that results in you having a poor outcome and you or your family comes back at us because we didn't attempt to explain the importance of a full exam and just said "the patient refused". 

Yes you have to right to refuse just like we have the right to explain why we want to do something (which may or may not have happened). 

In medicine refuses come with a lot of liability for the provider.


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## triemal04

Robb said:


> exposing a patient, especially in an injury with a high mechanism, is not one of them.


Was there a high mechanism?  In reading jim10036's posts I don't see anything to indicate that, unless one jumps to a lot of conclusions without having all the facts.  

Question:  Was he actually hit by a car or just lightly clipped?  If hit, at what speed?  Was he hit headon?  Rearended?  Broadside?  If broadside was the impact to the center of the bicycle, or did it hit the front/rear tire only?  Was he thrown from the bike or did he just lay it down?  If thrown, how far?  Did he just clip a car and get knocked off?  Did he himself run into a car?  If so, at what speed (for both car and bike)?

How about this for a scenario:  Jim10036 is riding and not paying attention (as unfortunately a lot of riders do), looks up, see's a STOPPED car in front of him, swerves to avoid it but hits the back with his front tire and falls to the ground next to his bike.  In doing so he lands on his hand and breaks it.  After arriving at the ER the EMT's report it as "a car versus bicycle accident," the nurses don't get any more info or solicit any, and jump to a conclusion based on a lack of information.

Like was done here.


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## jwk

jim10036 said:


> I am a cyclist (bike)...we wear shorts (bibs) with a jersey over them...they are very thin and light.....I had already unzipped my jersey so I really was only in my bib shorts....
> 
> I started out nice, and simply told the nurse no, she was not cutting off my bibs....it went down hill from there.



Unlike most of the others here, I'm with YOU.  Clearly some of the people here, like the ER nurses at the hospital you went to, aren't listening to what you're telling them and are assuming far too much.  Not what I'd consider "best practice".  I work with and deal with nurses all day every day.  Unfortunately, nursing, as well as medicine and even EMS, are moving far too much towards protocols, "best practices", and "pathways", and further away from listening to the patient.  

Do I understand the need to be able to examine a patient adequately?  Of course.  Do I think cutting off what little clothing you had on was necessary?  Not based on what you've said.  If they need your shorts off, you can certainly take them off - but they don't have to be cut off.  If I were you, I wouldn't have done it either.  

You could have just as easily gone to the ER on your own.  Had you walked into the ER and sat in the waiting room for a while, as opposed to the express route via EMS, you would not be getting a "full trauma exam including rectal examination".  Puhleeze.

All that being said - there are many cases where clothing certainly needs to be removed.  We tell our surgery patients to remove everything as well, although it many cases it's not necessary.  It's just "the protocol".  Do I care if you keep your underwear on while we're doing your carpal tunnel release or breast biopsy?  Nope, not at all.  But I'm always surprised at how many people keep their underwear on for surgery where it clearly has to come off.  Circumcision, inguinal hernia repair, D&C, hemorrhoids?  Uh, yeah, sorry, it's got to come off.


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## JPINFV

jwk said:


> You could have just as easily gone to the ER on your own.  Had you walked into the ER and sat in the waiting room for a while, as opposed to the express route via EMS, you would not be getting a "full trauma exam including rectal examination".  Puhleeze.



True, but I could easily see the bicycle v car brought in by ambulance being a trauma alert (most likely not an activation), which basically puts the trauma team on rails for the initial exam. Additionally, the last thing anyone wants to hear is, "Doctor, the patient had a significant enough mechanism prehospitally to require you to be present immediately on arrival. Why didn't you do a proper trauma exam?"


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## George 31

It's funny how your instructor tells you in school that you need to follow the national Registry federal mandates to a T and then things like this get questioned.   This issue really isn't even up for discussion. You undress the patients completely and follow your DCCAPBTLS sequence with bilateral palpations in a rapid focused and detailed physical examination. It's amazing how these states feel that they can come up with laws that supposedly supersede federal mandates of the national Registry.   The algorithms don't change from patient to patient or call to Call. There's a reason you have to go to school to be an EMT. We all went there and we know that 99% of all sexual abuse cases against an EMT are frivolous. 99 times out of 100 we don't have a doctor on board so much of our training is similar to what a physician learns.


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## NomadicMedic

George 31 said:


> It's funny how your instructor tells you in school that you need to follow the national Registry federal mandates to a T and then things like this get questioned.   This issue really isn't even up for discussion. You undress the patients completely and follow your DCCAPBTLS sequence with bilateral palpations in a rapid focused and detailed physical examination. It's amazing how these states feel that they can come up with laws that supposedly supersede federal mandates of the national Registry.   The algorithms don't change from patient to patient or call to Call. There's a reason you have to go to school to be an EMT. We all went there and we know that 99% of all sexual abuse cases against an EMT are frivolous. 99 times out of 100 we don't have a doctor on board so much of our training is similar to what a physician learns.



There is so much wrong with this , I don't even know where to start.


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## teedubbyaw

DEmedic said:


> There is so much wrong with this , I don't even know where to start.



NREMT mandates things on a federal level???

And I don't normally undress my patients to do a "rapid focused and detailed physical examination." 

This is like reading the replies to questions asked on the EMT facebook page. LOL


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## MonkeyArrow

DEmedic said:


> There is so much wrong with this , I don't even know where to start.


I especially like the "99 times out of 100 we don't have a doctor on board *so much of our training is similar to what a physician learns*."
I see, I see. Hey @JPINFV, you're an EM resident. Is what you're learning similar to what you were taught in EMT-B school?


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## JPINFV

George 31 said:


> 99 times out of 100 we don't have a doctor on board so much of our training is *similar to what a physician learns*.









My licensing exam review books are longer than my EMT book, and it doesn't have 1/4th page size pictures of what a handheld radio looks like.


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## NomadicMedic

Doctor books?


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## chaz90

"Me fix broken things." Yeah man, EMTs are just like ED docs. Don't let the rest of these ignoramuses stample your truth


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## DesertMedic66

George 31 said:


> It's funny how your instructor tells you in school that you need to follow the national Registry federal mandates to a T and then things like this get questioned.   This issue really isn't even up for discussion. You undress the patients completely and follow your DCCAPBTLS sequence with bilateral palpations in a rapid focused and detailed physical examination. It's amazing how these states feel that they can come up with laws that supposedly supersede federal mandates of the national Registry.   The algorithms don't change from patient to patient or call to Call. There's a reason you have to go to school to be an EMT. We all went there and we know that 99% of all sexual abuse cases against an EMT are frivolous. 99 times out of 100 we don't have a doctor on board so much of our training is similar to what a physician learns.


You must be new to EMS 

Take the majority of what you learned in EMT school and toss it in the trash. If you see a provider following NREMT skill sheets to the T odds are they are a brand new EMT or Medic.


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## Handsome Robb

Especially if they walk in with their hands above their head saying "BSI! The scene is safe!"


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## JPINFV

Handsome Robb said:


> Especially if they walk in with their hands above their head saying "BSI! The scene is safe!"




Is this the EMS version of "Hands up, don't shoot"?


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## Nightmare

if you are cutting the patients clothes off, they have more pressing matters to worry about than their clothes. dislocations, fractures, major trauma, cardiac arrests or if for w/e reason my ALS needs access to the patients chest yesterday. otherwise, do your best to take their clothes off without cutting.


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## Tigger

Yet for some reason EMS has a fetish about using shears on trauma patients. If the patient can take off the clothing, odds are it's not going to effect their care.


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## DesertMedic66

Tigger said:


> Yet for some reason EMS has a fetish about using shears on trauma patients. If the patient can take off the clothing, odds are it's not going to effect their care.


Not just EMS. Some of the hospitals around my area are obsessed with cutting patients cloths off. During my clinical hours we had a 46 y/o male who was having a STEMI. I asked the patient to take his shirt off. He was in the process of taking it off without any issue when a couple of nurses came over and cut his shirt off.


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## RedAirplane

George 31 said:


> It's funny how your instructor tells you in school that you need to follow the national Registry federal mandates to a T and then things like this get questioned.   This issue really isn't even up for discussion. You undress the patients completely and follow your DCCAPBTLS sequence with bilateral palpations in a rapid focused and detailed physical examination. It's amazing how these states feel that they can come up with laws that supposedly supersede federal mandates of the national Registry.   The algorithms don't change from patient to patient or call to Call. There's a reason you have to go to school to be an EMT. We all went there and we know that 99% of all sexual abuse cases against an EMT are frivolous. 99 times out of 100 we don't have a doctor on board so much of our training is similar to what a physician learns.



Being pretty new as well, I tend to agree with you. I just wanted to point out that sadly, we don't have a federal standard. The US DOT NHTSA sets guidelines but the states have to use them (or not) to set up their own EMS systems. The National Registry is a third party organization that facilitates proving that you have a certain amount of knowledge. They also set standards, but it is up to the states to adopt (or not). (So I understand).


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