I don't and never accused anyone of that...I did respond to a post that said they would be thrilled if we refused...which I thought was a little flippiant and responded in kind. Remember, I was in a bike race kit, I wasn't in a pair of jeans and sweatshirt, 95% of me was unclothed...and the 5% wasn't covered by much....why did it have to come off??? why could it not be shifted and moved to do the examination?? since when does a rectal exam require that a patient be completely unclothed? Frankly, it would have been reasonable under the circumstances for the physican to say sure, we can leave them on but we will have to pull them down to check this or that...but that was never offered; and frankly, I was so put off by the whole situation I would not have agreed to it anyway at that point (even if I thought it was necessary, which I did not, but that is another topic).
When to cut away a patient's clothes?
- Thread starter musicislife
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I don't and never accused anyone of that...I did respond to a post that said they would be thrilled if we refused...which I thought was a little flippiant and responded in kind. Remember, I was in a bike race kit, I wasn't in a pair of jeans and sweatshirt, 95% of me was unclothed...and the 5% wasn't covered by much....why did it have to come off??? why could it not be shifted and moved to do the examination?? since when does a rectal exam require that a patient be completely unclothed? Frankly, it would have been reasonable under the circumstances for the physican to say sure, we can leave them on but we will have to pull them down to check this or that...but that was never offered; and frankly, I was so put off by the whole situation I would not have agreed to it anyway at that point (even if I thought it was necessary, which I did not, but that is another topic).
If the patient does not want to remove his/her clothing then why, as professionals interested in our well being, would you not try to accommodate that reasonable request.....the examination in my case could have been done with shifting my clothing...what difference is it, in a case like mine, if you have to pull shorts down to examine the behind and do a rectal exam? None!
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I'm including the entire exam, not just rectal tone. I also never said we wouldn't accommodate a patient's request, just that it could prove to be a detriment to the care and is certainly not preferred. Look, I'm not in any position to tell you what you can do. If you refuse, that's your business. I am telling you a comprehensive, proper trauma exam is exceedingly difficult when the patient insists on wearing clothes. I won't continue to argue about this. Keep whatever opinion you need, but don't be surprised if you come to an EMS forum to "rant" and are told something other than you want to hear.
JPINFV
Gadfly
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Less work, more liability, and not really that much less work. There's more time spent trying to convince the patient that a full exam is necessary than the time it would take to actually do a proper trauma exam. Especially one where, based off of the description, the trauma team would be alerted and standing by for.
I do my job. My job doesn't depend on what a person looks like. Furthermore, there's no such thing as "hot" when it comes to a patient on a gurney. Actually, to be honest, when it comes to examining a patient the concept of judging their looks doesn't even cross my mind, regardless of what I have to examine.
You don't allow us to do a complete exam, we "miss" something, you sue. You, individually, might sue, but if you spin a roulette wheel enough times a zero pops up. We'd rather not spin the wheel at all.
It's not the injury we know about that concerns us. It's the injury we don't know about.
As far as removing vs cutting, I honestly don't know as I wasn't there. There have been patients where we simply removed the pants, and there are patients where we've cut the pants off. Without hearing what the trauma team heard, I honestly can't comment on the specifics.
thanks to everyone who responded....although you did not change my opinion, I really appreciate you taking the time to respond and share your thoughts on my question....please don't take this the wrong way, but I HOPE I never have need of EMT responders or have to go to the ED again. thanks again
JPINFV
Gadfly
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No, I said, "Yes, you have a right to refuse, but we have the right to no be thrilled when you do."
Now, it should have said "not be thrilled," however the negative "no" still results in the same sentiment that we'd rather you comply, just as a grammatical disaster of a sentence.
Edit: The rectal examination is looking for sensation, tone, and gross blood. It's archaic and current evidence shows that it really doesn't add much to the exam, but it's still the standard of care. During a trauma resuscitation exam, it's generally done at the same time we're rolling you and checking your back for injuries, pain, and deformities as well as removing the backboard. You're already rolled, so it's the easiest time to do it.
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Jim37F
Forum Deputy Chief
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When it comes to foot ware, would you just cut the laces? I have a pair of 10" Corcoran Jump Boots, and they can be tough to pull off that I'll usually just remove the laces to take them off. So if you had to remove boots, would you cut the laces or try to cut through the leather?
JPINFV
Gadfly
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What ever is the easiest and least destructive way. If we had to remove them, we would probably start with cutting the laces. We don't destroy clothing simply because we can.
zmedic
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I get pissed when my patients aren't undressed because it wastes my time. You are here for a foot problem? If I have to stand there while you take your shoes and socks off it slows me down. Rectal bleeding? People look at me like I'm crazy when I say I have to take a look.
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I have no idea why so many people get offended when the ED asks them to put on a johnny. It just isn't a big deal, and while everyone should be respectful of the patient's wishes, it cannot be avoided that the providers frankly know more about their own job than the patient does. Chances are, if a provider makes a request of you, it's in your own best interest however remote. If you don't want to do it fine, but don't get huffy with the staff over it.
I always lace all my shoes to be ems friendly trick learned in USMC flight line class toe side is over and all back are under along sides (that way there is always space under for scissors are a blade if they ever need expedious removal
the_negro_puppy
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When they are hot :wub:
JPINFV
Gadfly
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This is my favorite from about a week ago.
You're an alcoholic with abdominal pain and your hemoglobin dropped 4 points in 4 months. Yes... I've gotta do a rectal exam. No, I'm not looking forward to it, but yes... we need to rule out a GI bleed. Especially when you say yes when I ask if your stool has been black and tarry.
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How were you in a race suit and 95% uncovered? What were they trying to cut off of you?
Don't take this the wrong way but it sounds like you're self conscious. From your description the ER staff didn't approach the situation the right way but there are other variables to it. How did you approach them? If someone is being difficult I'm not nice, I always start out nice but if I get pushed I wont stay that way and I know I'm not the only one. I'm not saying you were difficult but your story doesn't make sense. How fast were you going? all you said was an accident on a motorcycle involving a car. That leaves things wide open. While mechanism of injury is a poor indicator of seriousness of injuries motorcycle accidents aren't taken lightly. It's been beaten to death, the injury that we don't know about yet is the scary one.
DesertMedic66
Forum Troll
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I was thinking that too. Race suits tend to cover your whole body. Why would you be riding a bike with less than 5% of your body covered? 5% is pretty much a thong + shoes + gloves and nothing else.....
EDIT: After going back through the older posts I think the poster was stating he was 95% uncovered after the responding EMTs took his jersey off.
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He's a bicyclist... he doesn't wear motorcycle racing leathers.
JPINFV
Gadfly
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Doesn't change much without more info to be honest. Motorcycle v car? Bicycle v car? Depending on the entire situation can be anywhere from dropped off at any ED to having an O on standby on arrival.
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The comment was how he was wearing so little clothing while riding a bike. I think some here were thinking motorcycle and not bicycle.
Achilles
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It seems the people that are in relatively the same career; EMS, Nursing, DO/MD or other healthcare position, can be the worst. I don't let it get to me though.
As for cutting clothes, I'll try to cut down the seam so you can sew it later on.
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Yes, you have a different skill set than most of those reporting in the ED.
And it was not, "take these off and put on this gown", the nurse came in and said Im going to have to cut this off of you...I hope you can imagine my surprise to this when I reported to the ED with only a broken hand.....and I did not get huffy until they got huffy....frankly, after doing research on line I discovered that states have had to enact patient's bills of rights...giving patients the right, among other things, to refuse treatment, and to refuse to disrobe. What is wrong with our medical care providers when law makers have had to go to such measures to protect patient's rights. No means no!
Mine was not a life or limb threatening case and to be treated as such was a huge waste of time, and frankly resources and money.
If I had needed a full exam I would not have had a problem with it...I still would have wanted to take off my bibs rather than having them cut off, but if I am in a condition where it is necessary to cut them off, cut away, I might not like it but my bibs are replaceable. My issue here was that it was NOT necessary with what I was presenting with.