When to cut away a patient's clothes?

[AnthonyM83]

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.

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]

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.

 

[paramedicjon]

Me

I vote cut baby, they arent my clothes.

 

[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.

 

[shiroun]

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:

 

[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.

 

[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.

 

[EMT1A]

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

 

[NomadicMedic]

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. :/

 

[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

 

[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.

 

[Achilles]

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]

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]

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]

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]

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]

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.