# Code brown



## HeadNurseRN (Mar 2, 2011)

It's funny to say sometimes "Code Brown" if you don't know what I am talking about you must :censored::censored::censored::censored: out ice cream. Seriously, I know BLS trucks carry bedpans and stuff like that but I heard two things if someone were to "Code Brown" in the truck. A paramedic told me to clean them up if there going to a rehab center or nursing home especially if there on hospice. Now an EMT told me there going to sit in it for the ride and to do nothing. I am just curious on what the right thing to do. I've worked in nursing homes with the elderly and when it happens I always help the aide right after I lock my med cart. The point is thats someones father or mother or uncle and I wouldnt want my family member to just sit in it. What is the right thing to do????


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## emt-mike (Mar 2, 2011)

I probably wouldn't clean it.
not because I want someone sitting in their own poo, 
but because there are generally bigger issues to take care of.


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## firetender (Mar 2, 2011)

*It's YOUR choice*

who are you? Are you a person who gets satisfaction out of being supportive of someone who can't take care of themselves; symbolically cleaning the muck off a child's face. Is that who you are? 

Or are you having a hard time finding the chapter about asswiping in your protocols?

You might even ask yourself is this particular person someone who's butt you want to polish?

Honestly, it's a :censored::censored::censored::censored:t y decision you have to make, but I would hope it would be based on the particular situation and patient rather than what anyone here says is THEIR way.

Find your own way, but asking for other perspectives is good as well!

Enjoy the time you've been given, even if your only tool is a washcloth!


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## EMTGunney (Mar 2, 2011)

*dont do it*

i have had a couple code browns and there isnt enough room in the back  of an ambulance to do that in my opinion, and it is not critical to pt care


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## MMiz (Mar 2, 2011)

Good 'ole code brown.  There just wasn't enough room in my van on the Stryker to do much to address the issue.  I've helped the NH address it when there, but there isn't much I can do when the patient is secured to the cot.


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## Smash (Mar 2, 2011)

There's nothing sexy about cleaning up feces, but it's even less sexy to die of sepsis from your infected decubitus ulcer either.  I was of the understanding that we are here to help people.  I wasn't aware that such help only involved sticking needles or tubes in them.  Perhaps I was wrong.

I'm just curious what it is that is critical to stop the patient dieing that is going on during interfacility transport, to such a point where basic and necessary patient care is ignored?


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## HeadNurseRN (Mar 2, 2011)

I read all these replies while laughing my *** off! Ha! I was just curious some people read waaaaay into this :censored::censored::censored::censored:, no bum intened. Ever disimpacted someone? That's fun! Thanks guys!!!!!


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## MrBrown (Mar 2, 2011)

*Brown sprints up in Browns now-shelved orange "DOCTOR" HEMS jumpsuit with Thomas pack slung over Browns shoulder and Lifepak in hand ....

Yes hello Dr Brown here, helicopter emergency medical service, you called?


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## bigbaldguy (Mar 2, 2011)

It's just poo, everybody poos  wipe it off clean it up and never speak of it again.


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## b2dragun (Mar 2, 2011)

I am 5 minutes from wherever I am dropping off...turn the exhaust fan on and open a window.  I am not cleaning anyone up, unless it is a dirty wound I don't clean.  If I worried about cleanliness then I would spend all my time cleaning, you have no idea how many of my pt's piss or code brown themselves.  The homeless I run on have weeks worth, the drunks have plenty too.  If it is a transfer then a couple minutes of being in feces won't kill them, chances are they lay in it for longer while at the facility anyways.  When in doubt I am more then willing to refer to my EMT-B and EMT-I books that do not make mention of this.


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## MasterIntubator (Mar 2, 2011)

This brings back many many memories of having to deal with the fruits of the gastrointestinal system.  Having to deal with the digestive leftovers is not enjoyable, and if you are weak... you are weak.  You will vomit with the best of us.
Many moons ago, I show up on a scene in an apartment complex, the BLS crew is standing outside the door, the fire guys are gladly leading us up to the second floor.... before I get a chance to get in the door, one of the EMTs advise me that they believe that the person is not hurt, and that it was definitely an ALS call. 
Well..... I turn the corner and sure enough, there was an elderly person lying on the floor with the ensure blues.  Mudbutt trails leading from the hallway to the phone in the living room.  It clicked.... those BLS :censored::censored::censored::censored::censored::censored::censored:s.  My crew and I look down from the breezeway.. the BLS crew and fire guys on their way to the rigs... "Forcible entry done... bye".  
I say "Thanks" loudly as I wave 'bye' with my middle finger.....  they are gonna get theirs..... ( and they did that night.....   as a few of my cardinal rules of EMS include don't funk with the ALS crews.... another is don't jump a call out of your due, you may regret it ).... they got theirs... ehh ehh - nother story.  We all come from the same station anyway, attitudes channel thru midnight revenge in the bunks with fun and learning...  )
Needless to say, we cleaned this guy up.... and transported him without further issue.  No doubt he was embarrassed and ashamed of his situation, and there is no worse feeling when you are all alone, and have a bubble-gutz situation that blevied from the crack, and no one will help.  Just imagine medical pros standing around with that disgust look on your faces.... just staring.... not moving, no action... the silence in the air as that sick person ( who is fully alert ) is begging for help silently....

I'm not gonna sit there.... some folks have made their minds up outside the door not to cross that threshold.  That there separates the weak from the strong.  This scenario is acceptable and well within our training and scope.... but we do have our down days.... someone has to do it.

( p.s.  It gets easier if you do happen to hurl..... whatever you do... don't try to swallow your puke back down.... it will backfire ) no pun intended


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## VFlutter (Mar 3, 2011)

b2dragun said:


> I am 5 minutes from wherever I am dropping off...turn the exhaust fan on and open a window.  I am not cleaning anyone up, unless it is a dirty wound I don't clean.  If I worried about cleanliness then I would spend all my time cleaning, you have no idea how many of my pt's piss or code brown themselves.  The homeless I run on have weeks worth, the drunks have plenty too.  If it is a transfer then a couple minutes of being in feces won't kill them, chances are they lay in it for longer while at the facility anyways.  When in doubt I am more then willing to refer to my EMT-B and EMT-I books that do not make mention of this.



Wow. So just because the nursing home or facility does not do their job properly or neglects their patients that gives you the right to do the same? That is so great logic. Maybe i am just naive but the core concept of our profession is to be a patient advocate. Sounds like you are doing a fantastic job. Also what makes a homeless or drunk person different? We should treat all patients with the same respect regardless of any other factor. Again maybe i am just being over sensitive but seriously what has happened to compassion for patients.


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## emt-mike (Mar 3, 2011)

I don't know about yours, but our ambulances don't have bathtubs in the back.


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## reaper (Mar 3, 2011)

These threads always bring the cream to the top. Shows which providers need to be run out of EMS and fast.

If you do not want to do the job, then leave. There are plenty more behind you that would be happy to help their fellow man.


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## VFlutter (Mar 3, 2011)

emt-mike said:


> I don't know about yours, but our ambulances don't have bathtubs in the back.



It is one thing to state that you do not have the adequate space to perform the task, which i  can understand. But you can still have the decency to use more appropriate language and not just say "Oh well they can just sit in it if they code brown"


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## Smash (Mar 3, 2011)

b2dragun said:


> I am 5 minutes from wherever I am dropping off...turn the exhaust fan on and open a window.  I am not cleaning anyone up, unless it is a dirty wound I don't clean.  If I worried about cleanliness then I would spend all my time cleaning, you have no idea how many of my pt's piss or code brown themselves.  The homeless I run on have weeks worth, the drunks have plenty too.  If it is a transfer then a couple minutes of being in feces won't kill them, chances are they lay in it for longer while at the facility anyways.  When in doubt I am more then willing to refer to my EMT-B and EMT-I books that do not make mention of this.



Hmmm... and still people complain that American EMTs don't get the respect or money that they deserve.
I would present this as evidence that for the most part, they get exactly what they deserve.


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## emt-mike (Mar 3, 2011)

I never said that I would let them sit in their own poo, I'm just saying I'd let somebody better equiped (i.e. a nursing home/hospital/whatever) handle the situation, instead of using chux and 4X4's to try and clean up a whole dirty stinky mess.


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## fast65 (Mar 3, 2011)

b2dragun said:


> I am 5 minutes from wherever I am dropping off...turn the exhaust fan on and open a window.  I am not cleaning anyone up, unless it is a dirty wound I don't clean.  If I worried about cleanliness then I would spend all my time cleaning, you have no idea how many of my pt's piss or code brown themselves.  The homeless I run on have weeks worth, the drunks have plenty too.  If it is a transfer then a couple minutes of being in feces won't kill them, chances are they lay in it for longer while at the facility anyways.  When in doubt I am more then willing to refer to my EMT-B and EMT-I books that do not make mention of this.



Hmmmm, I must have been sick the day when they mentioned that cleaning up a patient was below us. Weird.

I understand that it might be difficult because of the lack of space, and I certainly understand that it isn't the most pleasant part of the job, but it's just that, part of the job; if you can't deal with it, then you might want to choose a different career.


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## adamjh3 (Mar 3, 2011)

Do any of us want to spend time cleaning the microwave at station? Vaccuming the floors? Cleaning the bathroom where it seems like your co-workers pee everywhere but the toilet? Nope. But it's part of the job. I think y'all know where I'm going with this. 

If it's a code or there's some form of life threatening issue, no, I'm not going to spend my time wiping someone's bum-bum with some 4x4's. 

Our Tx's are usually pretty short, so I'll often wait until we're at the facility so there are more appropriate tools and adequate space and help the staff at the facility clean up. But I'm not just going to dump the pt off, get my signature and bail out of there like nothing happened.


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## Akulahawk (Mar 3, 2011)

*I just take a practical approach....*

Whether or not I attempt to clean the poo off the person while I'm in the back depends upon how far I'm from the destination. If I'm on scene, I'll try to assist the person attend to the porcelain goddess or clean them up prior to transport, if there's time. If it's going to be a while in transport, I'll do my best to clean 'em up. If the arrival time is short, I'll just bring 'em inside, let the staff know so they can get the stuff necessary and I'll help clean 'em up then. 

If the person KNOWS they've got to go... while in transport, I'll dig out the bedpan and get things prepared (hopefully) before the bowels burst. There really isn't a LOT of room in the back and if the patient has VERY liquid poo that is released under pressure... well, I'd rather contain rather than let the patient's poo spray all over, and then clean up. 

Sorry if that give anyone a rather Code Brown visual...


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## FrostbiteMedic (Mar 3, 2011)

Smash said:


> Hmmm... and still people complain that American EMTs don't get the respect or money that they deserve.
> I would present this as evidence that for the most part, they get exactly what they deserve.



I don't think this attitude is representative of the majority of EMT's, and I know it does not represent me. I treat my patient as if they were a member of my family, and if that means I clean poo, then I clean poo...AS the old, worn out saying goes, that patient is someone's relative.


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## emt-mike (Mar 3, 2011)

well, the thing about San Francisco, is that it's only 7 miles X 7 miles, with about 12 hospitals, so max transport time is about 10 minutes, not leaving a ton of time for the "fun stuff", I would never object to sticking around and helping the staff of the receiving facility clean up some poo, it's not beneath me, and nothing really grosses me out.


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## abckidsmom (Mar 3, 2011)

We have a pack of baby wipes for this purpose.  I clean poop for two reasons:  first, it's cruel to make people sit in it, if it's at all avoidable (actual hemodynamic instability is the only reason I'll skip cleaning poop), and second, that crap STINKs and i don't want it in my ambulance making me nauseous if I can help it.


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## reaper (Mar 3, 2011)

emt-mike said:


> well, the thing about San Francisco, is that it's only 7 miles X 7 miles, with about 12 hospitals, so max transport time is about 10 minutes, not leaving a ton of time for the "fun stuff", I would never object to sticking around and helping the staff of the receiving facility clean up some poo, it's not beneath me, and nothing really grosses me out.



The worst thing anyone can say is " it only 5 minutes to ED, so let them do it". That pt may have to sit in it at the ED for another 20 minutes, until they can get to them. What " Fun stuff" do you need to do? I don't care if you are in the parking lot of the ED. Take the time to clean the majority up. Plus, the ED staff won't look at you as an idiot!


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## Bieber (Mar 3, 2011)

b2dragun said:


> I am 5 minutes from wherever I am dropping off...turn the exhaust fan on and open a window.  I am not cleaning anyone up, unless it is a dirty wound I don't clean.  If I worried about cleanliness then I would spend all my time cleaning, you have no idea how many of my pt's piss or code brown themselves.  The homeless I run on have weeks worth, the drunks have plenty too.  If it is a transfer then a couple minutes of being in feces won't kill them, chances are they lay in it for longer while at the facility anyways.  When in doubt I am more then willing to refer to my EMT-B and EMT-I books that do not make mention of this.


You're lucky you're not my partner, 'cause that little comment right there would ensure that you WOULD be cleaning up every one of our patients on your own for a month or two, regardless of who was up.

I don't know who you think you are, but let me make something clear: you are not too good to clean up after your patients.  I am not too good to clean up after my patients.  NONE of us are too good to clean up after our patients.  And unless there's some more pressing issue present, we all SHOULD be cleaning up after our patients.

Medicine is more than just IVs and medications and intubation.  It's about being a decent human being and treating people with kindness and compassion.  We're there to treat their medical problems, yeah, but that doesn't mean we're not also there to treat their emotional, psychological, and yeah, even social problems as well.  Don't have a place to live?  Let me make sure the hospital puts you in contact with someone that can help you with that.  Need someone to vent to about all the :censored::censored::censored::censored: that made you want to take an overdose?  I'm a good listener.  Need someone to wipe your ***?  Yeah, I'll even do that.  And if you ever expect to be taken seriously as a provider or given any measure of respect, you'd better learn that your job doesn't start and stop with the medicine.


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## fast65 (Mar 3, 2011)

Bieber said:


> You're lucky you're not my partner, 'cause that little comment right there would ensure that you WOULD be cleaning up every one of our patients on your own for a month or two, regardless of who was up.
> 
> I don't know who you think you are, but let me make something clear: you are not too good to clean up after your patients.  I am not too good to clean up after my patients.  NONE of us are too good to clean up after our patients.  And unless there's some more pressing issue present, we all SHOULD be cleaning up after our patients.
> 
> Medicine is more than just IVs and medications and intubation.  It's about being a decent human being and treating people with kindness and compassion.  We're there to treat their medical problems, yeah, but that doesn't mean we're not also there to treat their emotional, psychological, and yeah, even social problems as well.  Don't have a place to live?  Let me make sure the hospital puts you in contact with someone that can help you with that.  Need someone to vent to about all the :censored::censored::censored::censored: that made you want to take an overdose?  I'm a good listener.  Need someone to wipe your ***?  Yeah, I'll even do that.  And if you ever expect to be taken seriously as a provider or given any measure of respect, you'd better learn that your job doesn't start and stop with the medicine.



+1

I don't know if anyone could have said it better


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## jjesusfreak01 (Mar 3, 2011)

I'm with Akulahawk on this one. I'll clean up a patient onscene before transport, or allow them to use their own restroom, but if they are chronically incontinent, they should be wearing Depends, and they can wait until they get to the hospital to get cleaned up if they do something in the back of the truck. The back of the truck is no place to be cleaning up patients. Its an uncontrolled environment, and you are bumping around constantly. I work IFT, and many of my elderly patients are overweight, making it a near impossible task anyway for myself to remove necessary seatbelts and roll the patients to clean them up. When working 911, transport is only going to be about 10 minutes for me, and the hospital employs CNAs who are paid and better trained to do this job.


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## abckidsmom (Mar 3, 2011)

Thanks to human physiology, it's completely rare for a person to have a bowel movement in the ambulance.  I was talking about in the house or facility.  I do not load poop onto the stretcher.


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## boingo (Mar 3, 2011)

I've cleaned plenty of folks in their home, but it wont be happening in the back of a moving vehicle.


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## emt-mike (Mar 3, 2011)

reaper said:


> The worst thing anyone can say is " it only 5 minutes to ED, so let them do it". That pt may have to sit in it at the ED for another 20 minutes, until they can get to them. What " Fun stuff" do you need to do? I don't care if you are in the parking lot of the ED. Take the time to clean the majority up. Plus, the ED staff won't look at you as an idiot!



 "fun stuff" refers to cleaning poo, also I expressly said I would stick around and help, but it's not happening in the back of the ambulance.


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## Akulahawk (Mar 3, 2011)

I should make one thing perfectly clear: It's not that I don't want my patient sitting in poop (because it's very irritating to the skin), it's because of the practicalities of attempting to clean up after a patient once in the back of the ambulance. I've had to do it (yes, more than once), and it's just this side of impossible... but it can be done. Clean 'em up before or after transport. If you can safely do it (and have time to do it safely) en-route, go ahead... hopefully you won't be bounced around into the poo.

While doing IFT or 911, if my patient needed cleaning upon arrival, I'd let the receiving RN know so that they can martial-up the needed supplies (and possibly arrange for a specimen gathering) while they're at it, before I arrive to minimize the amount of poo-sitting time.


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## TheyCallMeNasty (Mar 3, 2011)

IMO....If your not to far from the destination....wait till you get them there and clean them up at the facility usually they have a better enviro. for cleaning them up.....


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## Sasha (Mar 3, 2011)

I take it on a case by case basis. 

If it's a long transport, I will do my best. 

If they can help me by turning themselves, or at least holding the side rail to keep themselves turned, I will clean them up.

If I am two minutes from the facility and they're complete dead weight, sorry. I don't have enough room for my partner to come back there and help me roll and clean the patient.

I wont leave them in it, when we get to the facility and get them moved over, I will help change and clean the patient or do it myself if the nurses are taking forever.

I have no problem cleaning a patient. I will put them on a bed pan if they request it, help them get themselves into a urinal, and clean vomit or spit up from their faces, but sometimes it's just not possible to change or clean a patient's bottom in the back.


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## firetender (Mar 4, 2011)

*A Word In Defense of the Broken*

Let me step out on a limb here. 

Did you know that some medics' reality is call after endless call of moving around self-crippled human beings, suffering from all levels of diseases of choice who, given the opportunity to help themselves would much prefer to manipulate the world so that some poor EMS schmuck feels like he HAS to wipe his butt?

I'm talking willful manipulation and maybe poop is just a metaphor.

I've ridden or acted in services literally overdosed with human filth of thought, deed and body; call after call of relentless depravity. This is the Inner City with Many Names and the coldness and evil thoughts and deeds of the medics there are often hidden, even from themselves; perhaps especially from themselves. 

YES, there are some locations and some ambulance services where most every moment of every day your patients reflect human beings who have stopped trying; who have essentially lost the will to live. They literally  torture medics by being themselves because the medics don't really get to save anyone who really wants to live.

Or worse yet, they CAN'T save those who really do.

Can you imagine that? It's out there and some of your Brothers and Sisters suffer from over-exposure to it.

_*Self-disclosure: There was a period during my career, when assigned to such a station, I was more than willing to let many of my patients roll in their own. How many times in one day could I get my hands filthy?* (Gloved, of course!). A timely transfer saved me from the worst part of myself._

Something else I must say; it is possible that in the course of your career you may experience a string of calls that so deaden, demoralize and chill you that you may find yourself acting cruelly.

Human beings became medics to make some sort of an impact. Some end up in places or situations where they really, truly CANNOT and get a little crazy because of it. 

I'm sorry, but it's there, I've seen it and I've seen this kind of exposure first harden and then crumble once stellar medics and decent human beings; I came close myself.

Why would I offer this? Why would I rock this particular boat?

Because there are quite probably people reading this right now who are disturbed by these parts of themselves or these types of experiences. 

They would NEVER come forward for fear of judgments that so many have shown here.


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## HeadNurseRN (Mar 5, 2011)

Bieber said:


> You're lucky you're not my partner, 'cause that little comment right there would ensure that you WOULD be cleaning up every one of our patients on your own for a month or two, regardless of who was up.
> 
> I don't know who you think you are, but let me make something clear: you are not too good to clean up after your patients.  I am not too good to clean up after my patients.  NONE of us are too good to clean up after our patients.  And unless there's some more pressing issue present, we all SHOULD be cleaning up after our patients.
> 
> Medicine is more than just IVs and medications and intubation.  It's about being a decent human being and treating people with kindness and compassion.  We're there to treat their medical problems, yeah, but that doesn't mean we're not also there to treat their emotional, psychological, and yeah, even social problems as well.  Don't have a place to live?  Let me make sure the hospital puts you in contact with someone that can help you with that.  Need someone to vent to about all the :censored::censored::censored::censored: that made you want to take an overdose?  I'm a good listener.  Need someone to wipe your ***?  Yeah, I'll even do that.  And if you ever expect to be taken seriously as a provider or given any measure of respect, you'd better learn that your job doesn't start and stop with the medicine.



That's my answer to this thread


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## Rykielz (Mar 6, 2011)

As someone stated earlier, I take it on a case by case basis. If it's an IFT I have the nursing staff help me clean the patient before we even leave. If it happens during transport you get a bedpan and help clean the patient when you've transported them to the new facility. By no means am I or anyone else "too good" to take five extra minutes to keep a patient clean and prevent sepsis.

However, 9-1-1 is a whole different story altogether. Many times your going to find that you just do not have the time to treat and assess a patient AND clean them during transport. If time permits, then by all means I'll do it; but most of the time this isn't the case. In any case EMS is all about patient care and customer service, if you don't clean them in the ambulance at least make sure they get cleaned at the hospital or long-term care facility. Little things like that make all the difference.


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## tao (Mar 8, 2011)

For all of you who say that you aren't going to clean anyone up, shame on you, you are not a healthcare professional.  If my loved one were in the back of your ambulance and you refused to clean them, I would have your job.

As some have said, it's a case-by-case basis.  Can the patient turn themselves (even a little)?  Are they free of injuries that would complicate maneuvering them to take care of the mess?  Then clean them.

If the patient has a broken hip, on the other hand, the cleaning is best left in the hands of RNs and their cool wedge-pillows.

The least you can do is clean the patient when you are in the ER and have more space to maneuver.


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