clothing removal

[billycorgi]

Hello,

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

 

[DesertMedic66]

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

 

[mycrofft]

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

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

 

[Handsome Robb]

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

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

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

 

[mycrofft]

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

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

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

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

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

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

 

[unleashedfury]

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

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

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

 

[DesertMedic66]

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

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

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

Defiantly not by cutting down jackets inside the rig.

 

[Handsome Robb]

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

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

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

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

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

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

Might've had to do this more than once

 

[mycrofft]

Defiantly not by cutting down jackets inside the rig.

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

 

[mycrofft]

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

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

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

Might've had to do this more than once

That needs to get into the texts.

 

[medicsb]

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

 

[Handsome Robb]

That needs to get into the texts.

Well thank you sir, I appreciate that.

 

[TheLocalMedic]

 

[mycrofft]

hah!

 

[RebelAngel]

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

 

[Carlos Danger]

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

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

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

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

 

[medicsb]

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

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

 

[ZombieEMT]

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

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

 

[mycrofft]

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

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

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

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

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

 

[gotbeerz001]

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

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

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

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

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

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