Cutting Clothes

[micsaver]

Yes, before you mention it I did look it up and read some old posts on the subject. The posts I found mostly talked about cutting clothes on major trauma pts.

We didn't cover this well at all in my training. Actually it was just mentioned.
How do you cut a persons clothes off? Is there a particular way you find easier with minimal pt movement and privacy?

My next question is if a pt has a fractured arm/leg or a cut and is fully conscious they can refuse anything at any point right. So If they are upset and don't want you to cut their new pants what do you do?

 

[medic417]

They say don't cut, don't cut. You can explain the need to expose and the risks involved if they refuse. But if you cut after they say no you just bought them new clothes and could be charged with a crime.

As to clothes cutting techniques, you will see many. Some are faster, some allow patients more privacy. But on a major trauma every inch of skin is exposed so you miss nothing. Anyone tells you otherwise is setting you up to miss something. But again a patient that is alert can still refuse to allow you to cut clothes just as they can refuse any and all treatments.

 

[Scout]

Along seams so they can be re sown if wanted is what we usualy say. I tend to just cut as much as i need, say if i need to look at the lower leg i cut up to the knee, if i want a collar on i'll just cut off the collar/hood.

And yes they can tell you to sod off. Did you try to remove the cloths? Alot of the time you can remove cloths with minimal movement. As fun as cutting is you dont always need to do it.

 

[micsaver]

I havn't come across this situation yet. I do mostly dialysis transports. Maybe I can get my girlfriend to put on some old cloths so I can practice

 

[medic417]

I havn't come across this situation yet. I do mostly dialysis transports. Maybe I can get my girlfriend to put on some old cloths so I can practice

Just be careful not to cut any vital body parts.

 

[RESQ_5_1]

If my pt is councious and A/Ox4, I leave it up to them generally. Unless major trauma is involved. I have found that 99% of the people I have to cut clothes off of usually throw those clothes out afterwards even though I cut along the seam.

However, up here in Canada, there are many more layers to deal with during the winter. And, if you have ever tried to remove a pair of $500 snowmobile boots from a fractured ankle, you will find the pt is much more willing to let you cut them without getting mad once you start making the attempt.

 

[vquintessence]

Consent for evaluation and treatment aside, just cut up the middle of the legs until you get to the hip area, otherwise leave the pants around the genitals alone.
For men: Unless Lorena Bobbit was on scene, his nuts are in a padlock (Jay Leno headline segment anyone?) or there is localized or penetrating injury, you could forgo the exposure. Also for spinal insults, ya usually don't need to expose the genitals to look for a priaprism.
For women: (assuming you're a male), ya probably don't want to be peeking unless it's OB/GYN or again, there is high likelihood of localized injury. It's too much of an easy target to sue the male attendant who is alone in the back of a moving vehicle for molestation. The criminal suit will probably not stick... but the civil suit... the one with the $$ compensation could be much easier to win. The lawyers only have to prove % liability, not beyond a shadow of a doubt.

Just be careful not to cut any vital body parts.

Are toes ok?

 

[motownems]

I routinely ask the pt if I can help them remove their jacket/sweatshirt/hoody. Once I explain that it would make it easier for me to obtain an accurate bp I have never had a pt refuse.

As far as the high speed cutting clothing of a trauma pt, I have only done that twice. Both times the pts were unresponsive. As for the technique, strait up the middle of the shirt (if it’s a button down it can be ripped) than straight up the sleeve to the collar; same thing with the pants straight up the leg to the waist. However for the sake of the privacy of the pt I am of the opinion that this should only be done in the back of the rig, either that or get a wall of FF to stand facing out around you and the pt.

completely aggree with vquintessence about how this makes the provider an easy target...

 

[PapaBear434]

I had a guy that didn't want me to cut off his boots even though he had a fractured ankle and his boot was full of blood. I couldn't just cut the laces, as he had some weird wire laces that I had never seen before or since, and my sheers (big ones that look like poultry sheers) couldn't cut through them. His foot was swelled to the point that I couldn't get the boot off without him screaming.

So I finally told him that I could cut off the boot, or the OR was going to cut off his foot. He finally relented and I cut down the side. Big honkin' sheers came in handy for that.

People need perspective. Yeah, it sucks that your clothing is going to get cut. No, I don't care how much you paid for it. Yes, it's likely ruined by blood or road rash anyway. Just let me cut and do what I need to do.

Most of the time, you can just remove the article of course. But when you have a knee dislocation, you can't realistically do that.

 

[medic417]

Consent for evaluation and treatment aside, just cut up the middle of the legs until you get to the hip area, otherwise leave the pants around the genitals alone.
For men: Unless Lorena Bobbit was on scene, his nuts are in a padlock (Jay Leno headline segment anyone?) or there is localized or penetrating injury, you could forgo the exposure. Also for spinal insults, ya usually don't need to expose the genitals to look for a priaprism.
For women: (assuming you're a male), ya probably don't want to be peeking unless it's OB/GYN or again, there is high likelihood of localized injury. It's too much of an easy target to sue the male attendant who is alone in the back of a moving vehicle for molestation. The criminal suit will probably not stick... but the civil suit... the one with the $$ compensation could be much easier to win. The lawyers only have to prove % liability, not beyond a shadow of a doubt.



Are toes ok?

I would disagree. On major trauma total exposure is required or you may miss indications of other injurys. You can not go through life in fear of law suits. Be consistent in how you treat. If you cut off all the hot girls clothes cut off all the fat mans clothes too.

Toes aren't critical to his needs unless he has a weird fetish.:unsure:

 

[BossyCow]

Trauma shears are wonderful! I generally go for the seams if the clothing looks like a favorite and can be saved. Otherwise it's the shortest most direct route to full visualization of the pt. Up the center, down the sleeves. I've bunched up the fabric and cut chunks instead of working my way slowly up a sleeve, depends on the pt's status.

 

[medic417]

Trauma shears are wonderful! I generally go for the seams if the clothing looks like a favorite and can be saved. Otherwise it's the shortest most direct route to full visualization of the pt. Up the center, down the sleeves. I've bunched up the fabric and cut chunks instead of working my way slowly up a sleeve, depends on the pt's status.

I like that point. Most never teach that to the new guy. This is also an important reason to either replace cheap shears pretty much after each complete exposure or buy a good pair that stays sharp. Limit the amount of times you have to actually open and close the shears. Work smarter not harder.

 

[firecoins]

I cut everything but I have a blanket set up for privacy once I have checked for injuries.

 

[Sasha]

I like that point. Most never teach that to the new guy. This is also an important reason to either replace cheap shears pretty much after each complete exposure or buy a good pair that stays sharp. Limit the amount of times you have to actually open and close the shears. Work smarter not harder.

And don't use them to cut wrapping paper at Christmas. I figured out that dulls the blade pretty quick too.

 

[rescuepoppy]

About the only thing I wont cut is a motorcycle club jacket. Had to treat a member of a well known motorcycle club once for a possible d/l shoulder. We were able to get his jacket off. I had already told one of his buddies that if we had to cut it that I would give him my shears.

 

[BossyCow]

And don't use them to cut wrapping paper at Christmas. I figured out that dulls the blade pretty quick too.

Besides, makes the edges of the wrapping paper all jagged... ask me how I know that!

 

[medic417]

Besides, makes the edges of the wrapping paper all jagged... ask me how I know that!

Did your Paramedic give you a gift with rough edges?

 

[BossyCow]

Did your Paramedic give you a gift with rough edges?

That's a sort of personal question isn't it? But no.. as difficult as this may be for you to accept.. I actually use trauma shears myself.... not all of my EMS experience comes vicariously through my husband....

I do recall one Christmas though, when my husband was working a lot of overtime around the holidays and had stashed the kids presents in his room at work. He brought them home Christmas morning wrapped in red biohazard bags and tied with crime scene tape yellow bows and duct tape.

 

[micsaver]

... Otherwise it's the shortest most direct route to full visualization of the pt. Up the center, down the sleeves.

There is a good point. It's probably not a good idea to go cutting the sleeves with your sheers going towards the pt's face. See lot's of good tips and techniques that I wish I would have been shown (or tried) in class.

 

[Tincanfireman]

And since no one has mentioned it yet, if the pt. absolutely refuses your attempt/advice to remove their garments with scissors, document it thoroughly. You might also let them know that ER personnel tend to cut first and ask second, so they're most likely to end up with a bio bag full of bloody rags anyway. Also, remember that when you remove their clothes, they are gonna lose a good bit of body heat in a hurry, so have those blankets ready to go and keep that ambulance toasty.