When to cut away a patient's clothes?

[jim10036]

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.

I am a cyclist (bike)...we wear shorts (bibs) with a jersey over them...they are very thin and light.....I had already unzipped my jersey so I really was only in my bib shorts....

I started out nice, and simply told the nurse no, she was not cutting off my bibs....it went down hill from there.

 

[jim10036]

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.

If I report with rectal bleeding you bet you are looking down there, but if I report with a broken hand, nope.

 

[jim10036]

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.[/QUOTE]

If I could have ridden my bike to the hospital I would have....but the front wheel was cracked....I don't know what they heard but it was probably something along the lines of male reporting with broken hand, conscious, alert, standing and walking on arrival with no other complaint, pain or injury. The paramedics were not insisting that I go to the hospital, we talked and discussed it for a while, they cleaned up the road rash while I talked with the police who had responded, but in the end, I decided it would be better to get my hand looked at right away...

 

[Achilles]

If I could have ridden my bike to the hospital I would have....but the front wheel was cracked....I don't know what they heard but it was probably something along the lines of male reporting with broken hand, conscious, alert, standing and walking on arrival with no other complaint, pain or injury. The paramedics were not insisting that I go to the hospital, we talked and discussed it for a while, they cleaned up the road rash while I talked with the police who had responded, but in the end, I decided it would be better to get my hand looked at right away...

And part of looking at your hand included an trauma assessment. (you need to see the extremities to do this as well as the abdomen, and the back.)

 

[jim10036]

And part of looking at your hand included an trauma assessment. (you need to see the extremities to do this as well as the abdomen, and the back.)

Maybe, but the original issue was why was it necessary to try to cut off my clothing...why, given the circumstances could the trauma assessment not have been done with my clothing on....little as it was. Why could they have just agreed and said, sure but we will have to move it to check this or that....Someone accused me of having modesty issues, maybe I do, but no one wants to be stripped lying naked on a table when their complaint is a broken hand...when it needs to be done, it needs to be done, but this was not a situation in my opinion that warranted it....and fortunately, I have the final say. No means no....and and as soon as I said no their attitude changed....mine changed to match theirs.

 

[NomadicMedic]

I think the point has been made. You didn't want your clothes cut off, the ED staff did. You both disagreed, treatment was rendered, you went home.

Lets move on.

 

[Brandon O]

No clothing is allowed in my ambulance. Patients or providers.

Observers may wear a small fig leaf, but only one. Front or back, dealer's choice.

 

[JPINFV]

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!

Short of being mandated to accept treatment due to being incompetent due to psychatric illness, a competent patient can refuse anything. There's nothing new or magical or special about that. However, again, the medical and nursing staff will push for what we think is in your best interest. You can lead a horse to water, but you can't make him drink.

My issue here was that it was NOT necessary with what I was presenting with.

You were presenting as a bicycle vs car. The bicycle normally loses that encounter, and normally loses hard.

 

[Akulahawk]

Short of being mandated to accept treatment due to being incompetent due to psychatric illness, a competent patient can refuse anything. There's nothing new or magical or special about that. However, again, the medical and nursing staff will push for what we think is in your best interest. You can lead a horse to water, but you can't make him drink.


You were presenting as a bicycle vs car. The bicycle normally loses that encounter, and normally loses hard.

That's putting it mildly. One of the more interesting calls I'd ever had involved that very same MOI. Patient was thrown into a very soft dirt berm. The bicycle was still upright. Straight upright. It's front wheel was buried in that berm. The rear wheel resembled a taco... Aside from being a bit angry about being hit by a car, being a bit dusty on the back, and having to replace the wheel, the rider was completely uninjured. Not even so much as a bit of road rash.

There was a GREAT outline of the patient's body in the dirt berm after we got him up and out of it. We could even see seams and shirt wrinkles!

 

[Handsome Robb]

He's a bicyclist... he doesn't wear motorcycle racing leathers.

That clears things up. Still was covered more than 5% even without a jersey on.

Sure we can move loose clothes out of the way, tight spandex? Definitely not.

The more I read and think the more it seems like you might have had an attitude and got attitude in return.

We don't do things for no reason. Alright, sometimes we do but exposing a patient, especially in an injury with a high mechanism, is not one of them.

 

[Handsome Robb]

Maybe, but the original issue was why was it necessary to try to cut off my clothing...why, given the circumstances could the trauma assessment not have been done with my clothing on....little as it was. Why could they have just agreed and said, sure but we will have to move it to check this or that....Someone accused me of having modesty issues, maybe I do, but no one wants to be stripped lying naked on a table when their complaint is a broken hand...when it needs to be done, it needs to be done, but this was not a situation in my opinion that warranted it....and fortunately, I have the final say. No means no....and and as soon as I said no their attitude changed....mine changed to match theirs.

Because clothing hides things. See my post above this one about loose clothing versus tight clothing.

I don't understand what you don't understand about this. We live in a sue happy society. How do we know that if you refuse to disrobe or allow us to disrobe you so we can do a proper assessment and you end up having an undiscovered injury that results in you having a poor outcome and you or your family comes back at us because we didn't attempt to explain the importance of a full exam and just said "the patient refused".

Yes you have to right to refuse just like we have the right to explain why we want to do something (which may or may not have happened).

In medicine refuses come with a lot of liability for the provider.

 

[triemal04]

exposing a patient, especially in an injury with a high mechanism, is not one of them.

Was there a high mechanism? In reading jim10036's posts I don't see anything to indicate that, unless one jumps to a lot of conclusions without having all the facts.

Question: Was he actually hit by a car or just lightly clipped? If hit, at what speed? Was he hit headon? Rearended? Broadside? If broadside was the impact to the center of the bicycle, or did it hit the front/rear tire only? Was he thrown from the bike or did he just lay it down? If thrown, how far? Did he just clip a car and get knocked off? Did he himself run into a car? If so, at what speed (for both car and bike)?

How about this for a scenario: Jim10036 is riding and not paying attention (as unfortunately a lot of riders do), looks up, see's a STOPPED car in front of him, swerves to avoid it but hits the back with his front tire and falls to the ground next to his bike. In doing so he lands on his hand and breaks it. After arriving at the ER the EMT's report it as "a car versus bicycle accident," the nurses don't get any more info or solicit any, and jump to a conclusion based on a lack of information.

Like was done here.

 

[jwk]

I am a cyclist (bike)...we wear shorts (bibs) with a jersey over them...they are very thin and light.....I had already unzipped my jersey so I really was only in my bib shorts....

I started out nice, and simply told the nurse no, she was not cutting off my bibs....it went down hill from there.

Unlike most of the others here, I'm with YOU. Clearly some of the people here, like the ER nurses at the hospital you went to, aren't listening to what you're telling them and are assuming far too much. Not what I'd consider "best practice". I work with and deal with nurses all day every day. Unfortunately, nursing, as well as medicine and even EMS, are moving far too much towards protocols, "best practices", and "pathways", and further away from listening to the patient.

Do I understand the need to be able to examine a patient adequately? Of course. Do I think cutting off what little clothing you had on was necessary? Not based on what you've said. If they need your shorts off, you can certainly take them off - but they don't have to be cut off. If I were you, I wouldn't have done it either.

You could have just as easily gone to the ER on your own. Had you walked into the ER and sat in the waiting room for a while, as opposed to the express route via EMS, you would not be getting a "full trauma exam including rectal examination". Puhleeze.

All that being said - there are many cases where clothing certainly needs to be removed. We tell our surgery patients to remove everything as well, although it many cases it's not necessary. It's just "the protocol". Do I care if you keep your underwear on while we're doing your carpal tunnel release or breast biopsy? Nope, not at all. But I'm always surprised at how many people keep their underwear on for surgery where it clearly has to come off. Circumcision, inguinal hernia repair, D&C, hemorrhoids? Uh, yeah, sorry, it's got to come off.

 

[JPINFV]

You could have just as easily gone to the ER on your own. Had you walked into the ER and sat in the waiting room for a while, as opposed to the express route via EMS, you would not be getting a "full trauma exam including rectal examination". Puhleeze.

True, but I could easily see the bicycle v car brought in by ambulance being a trauma alert (most likely not an activation), which basically puts the trauma team on rails for the initial exam. Additionally, the last thing anyone wants to hear is, "Doctor, the patient had a significant enough mechanism prehospitally to require you to be present immediately on arrival. Why didn't you do a proper trauma exam?"

 

[George 31]

It's funny how your instructor tells you in school that you need to follow the national Registry federal mandates to a T and then things like this get questioned. This issue really isn't even up for discussion. You undress the patients completely and follow your DCCAPBTLS sequence with bilateral palpations in a rapid focused and detailed physical examination. It's amazing how these states feel that they can come up with laws that supposedly supersede federal mandates of the national Registry. The algorithms don't change from patient to patient or call to Call. There's a reason you have to go to school to be an EMT. We all went there and we know that 99% of all sexual abuse cases against an EMT are frivolous. 99 times out of 100 we don't have a doctor on board so much of our training is similar to what a physician learns.

 

[NomadicMedic]

It's funny how your instructor tells you in school that you need to follow the national Registry federal mandates to a T and then things like this get questioned. This issue really isn't even up for discussion. You undress the patients completely and follow your DCCAPBTLS sequence with bilateral palpations in a rapid focused and detailed physical examination. It's amazing how these states feel that they can come up with laws that supposedly supersede federal mandates of the national Registry. The algorithms don't change from patient to patient or call to Call. There's a reason you have to go to school to be an EMT. We all went there and we know that 99% of all sexual abuse cases against an EMT are frivolous. 99 times out of 100 we don't have a doctor on board so much of our training is similar to what a physician learns.

There is so much wrong with this , I don't even know where to start.

 

[teedubbyaw]

There is so much wrong with this , I don't even know where to start.

NREMT mandates things on a federal level???

And I don't normally undress my patients to do a "rapid focused and detailed physical examination."

This is like reading the replies to questions asked on the EMT facebook page. LOL

 

[MonkeyArrow]

There is so much wrong with this , I don't even know where to start.

I especially like the "99 times out of 100 we don't have a doctor on board so much of our training is similar to what a physician learns."
I see, I see. Hey @JPINFV, you're an EM resident. Is what you're learning similar to what you were taught in EMT-B school?

 

[JPINFV]

99 times out of 100 we don't have a doctor on board so much of our training is similar to what a physician learns.

My licensing exam review books are longer than my EMT book, and it doesn't have 1/4th page size pictures of what a handheld radio looks like.

 

[NomadicMedic]

Doctor books?