Cutting Clothes

[Grady_emt]

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.

That is about the only time I try to save something is when cutting a rider's leathers. Go for the seams, or right next to it so they can be repaired, or if there are laces (like up the sides of pants/chaps) go for those as new lacing is easy to obtain

And if youre cutting a jacket, make sure it's not a down filled one, they make a mess, unless you want to look like you've been tarred and feathered.

 

[daedalus]

What is the taboo with exposing the genitals? Its a part of the body, subject to getting injured, and in major trauma it needs to be exposed. If we are medical professionals than we should act like it. Doctors do not get out of digital rectal exams and pelvics, no matter if they are male or female. It is a vital part of an exam.

 

[BossyCow]

What is the taboo with exposing the genitals? Its a part of the body, subject to getting injured, and in major trauma it needs to be exposed. If we are medical professionals than we should act like it. Doctors do not get out of digital rectal exams and pelvics, no matter if they are male or female. It is a vital part of an exam.

With an unconscious or critical pt, or a major trauma absolutely. But with some pt's they feel vulnerable enough being sick or injured and in the back of the rig that the indignity of exposure is difficult. I generally take my cue from the pt. I've seen little old ladies fling their clothing aside without a second thought and a grown man who was absolutely mortified that his injury happened while he was taking a whizz outside and his pants were unzipped. He asked one of the guys on scene to zip him up before we flipped him over onto the backboard.

I think its possible to walk a middle line here. We remove clothing as necessary, and attempt to preserve the modesty of the patient within their comfort level whenever we can. Those are the only rules I follow.

 

[marineman]

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.

This is a good point and in that case I would agree. There's not much we can do in the field for a dislocated shoulder with a jacket off that we couldn't do with it on and it's generally good not to agitate your patients too much.

On the other hand there are a few around here that refuse to cut motorcycle leathers period. In the case of a MVC on a motorcycle there's a good probability of major trauma so I won't give that a second thought. If you're involved in a major trauma and get upset when I cut your $200 jacket just wait until you get the ER bill.

 

[Sasha]

What is the taboo with exposing the genitals? Its a part of the body, subject to getting injured, and in major trauma it needs to be exposed. If we are medical professionals than we should act like it. Doctors do not get out of digital rectal exams and pelvics, no matter if they are male or female. It is a vital part of an exam.

I agree with you!! I had a partner at my old job who was so shy about this he refused to perform exams on females. Granted we were IFT and the exams were not super vital, but he wouldn't listen to breathe sounds, wouldn't look at the dressing on the woman's upper thigh. Jeez louise!

 

[medic417]

I agree with you!! I had a partner at my old job who was so shy about this he refused to perform exams on females. Granted we were IFT and the exams were not super vital, but he wouldn't listen to breathe sounds, wouldn't look at the dressing on the woman's upper thigh. Jeez louise!

Sounds like he needs out of EMS. Our job is a touchy, feely, looky at that job.

 

[Sasha]

Sounds like he needs out of EMS. Our job is a touchy, feely, looky at that job.

Well I feel he didn't have a very good EMT class. This is the partner who couldn't take a blood pressure and had to be taught. You don't automatically feel comfortable touching and assesing people in private areas often viewed as "taboo" by general public. It's something you gotta get comfortable with.

At least I wasn't comfortable first off.

 

[medic417]

Well I feel he didn't have a very good EMT class. This is the partner who couldn't take a blood pressure and had to be taught. You don't automatically feel comfortable touching and assesing people in private areas often viewed as "taboo" by general public. It's something you gotta get comfortable with.

At least I wasn't comfortable first off.

I guess I have been doing it so long I do not even realize I am doing it. Thinking back to my first EMS course I recall one of the instructors while teaching how to listen to breath sounds getting onto me for improperly doing it. I went to low to avoid her large breast. She took my hand made me lift it and listen in proper location. So ever since I just do what needs being done.

 

[daedalus]

I remember the first time I had to lift a particularly large breast out of the way to do a 12 lead. It was awkward but ever since than I have been fine.

 

[firecoins]

I remember the first time I had to lift a particularly large breast out of the way to do a 12 lead. It was awkward but ever since than I have been fine.

I got quite used to doing this in the hospital during clinicals as well.

 

[PapaBear434]

I remember the first time I had to lift a particularly large breast out of the way to do a 12 lead. It was awkward but ever since than I have been fine.

I had a woman lift her own my first time. She just goes "Oh, there ya go, young man. The ol' saggin' tits do get in the way from time to time."

That pretty much killed any sense of modesty I had left.

 

[vquintessence]

Heh, never said I was afraid of exposing them completely when necessary. But really medic417 and Daedalus, you guys advocate exposure to every trauma pt to do a complete assessment? My refusal to do that goes beyond lawsuits, because if anyone was really that afraid of em, they wouldn't be in health care. When does privacy or modesty come into consideration?

"Sir, you have an angulated ankle fx after a trench collapse. You have poor distal CSM (PMS, whatever you all use). You deny pain other than what's isolated at your ankle, but I need to cut off all your clothing to fully understand what's going on with you." Hell, might as well go the whole 9 yards and backboard the fella c high flow O2.

"Ma'am, you state severe LLQ abd pain, deny pregnancy, deny intercourse, but since you are in child bearing age (13-60'ish) and I don't believe you, I need to examine your genitalia for fear of bleeding secondary to ectopic pregnancy."

Bossycow put it best with walking the middle line.

Kind of related: How does everyone feel with cutting the clothes of a homeless person? In New England or anywhere north of the Mason-Dixie line.

 

[medic417]

Heh, never said I was afraid of exposing them completely when necessary. But really medic417 and Daedalus, you guys advocate exposure to every trauma pt to do a complete assessment? My refusal to do that goes beyond lawsuits, because if anyone was really that afraid of em, they wouldn't be in health care. When does privacy or modesty come into consideration?

"Sir, you have an angulated ankle fx after a trench collapse. You have poor distal CSM (PMS, whatever you all use). You deny pain other than what's isolated at your ankle, but I need to cut off all your clothing to fully understand what's going on with you." Hell, might as well go the whole 9 yards and backboard the fella c high flow O2.

"Ma'am, you state severe LLQ abd pain, deny pregnancy, deny intercourse, but since you are in child bearing age (13-60'ish) and I don't believe you, I need to examine your genitalia for fear of bleeding secondary to ectopic pregnancy."

Bossycow put it best with walking the middle line.

Kind of related: How does everyone feel with cutting the clothes of a homeless person? In New England or anywhere north of the Mason-Dixie line.

Guess you did not pay attn to the statement major trauma?

And actually the female scenario you joke about does require a visual exam.

Honestly we should start exposing more patients. To many just want to sit and do nothing rather than actually examine their patients.

 

[EeyoreEMT]

girls, boys and lawsuits

When a male has a female pt, especially underage, it is very wise to have your partner have their mirror turned to see you and the pt, if you can, swtich with a female or have an additional person in the back so it's not 1-1. If it's critical, who care, expose, treat-go! I found myself with a partner one time that liked to look at the girls a bit too much, unnecessary cutting and exposing!! What I did was get to them first and if they had to be exposed I would do it with modesty if they were concious or if bystanders and have them covered with blankets and on backboard by the time my partner could say anything, and he knew the mirror was always there, for his protection and hers!!

 

[vquintessence]

zealous assessment vs right to privacy

Guess you did not pay attn to the statement major trauma?

And actually the female scenario you joke about does require a visual exam.

Honestly we should start exposing more patients. To many just want to sit and do nothing rather than actually examine their patients.

Jeez, disagreement is no reason to be smarmy! Everyone here has implied that major trauma/illness justifies exposure. Otherwise it's personally discretionary. The LLQ pain I was "joking" about could have enough other etiologies for me to not deem a visual examination of the genitalia immediately necessary. It's all about differential diagnosis. No need to pretend that a vastly different level of care is being offered through these different viewpoints. Regardless we won't see eye to eye.

 

[medic417]

Jeez, disagreement is no reason to be smarmy! Everyone here has implied that major trauma/illness justifies exposure. Otherwise it's personally discretionary. The LLQ pain I was "joking" about could have enough other etiologies for me to not deem a visual examination of the genitalia immediately necessary. It's all about differential diagnosis. No need to pretend that a vastly different level of care is being offered through these different viewpoints. Regardless we won't see eye to eye.

I did not give you a smarty reply. I politely answered in rebuttal to your statement.
Just because my answer is from a different view than you you have chosen to act as if I attacked you. Would you prefer all her just to agree with you? There is no learning if we are unable to express our educated opinions based on our experience.

 

[marineman]

hmmm... this one could be heading to a lock soon so I'll just throw in if you have to lift the girls to assess breath sounds or apply the monitor make sure that you're using the back of your hand to lift it.

 

[medic417]

hmmm... this one could be heading to a lock soon so I'll just throw in if you have to lift the girls to assess breath sounds or apply the monitor make sure that you're using the back of your hand to lift it.

Actually Tim Phalen in 12 lead video lifts by cupping breast. So education is palm not back of hand. But I see why most use back of hand.

 

[marineman]

Honest question, is there any reason to use palm? To me by using the back of the hand you accomplish the same thing and it removes any doubt as to what your intentions are.

 

[PapaBear434]

Honest question, is there any reason to use palm? To me by using the back of the hand you accomplish the same thing and it removes any doubt as to what your intentions are.

Agreed. That's why they also taught us to check for sternum fractures with the blade of our hand rather than flat hand or fingers, and why you only do a check on a femoral pulse in the most dire of situations.