When to cut away a patient's clothes?

[Aidey]

Whats the point of bringing them in nude? Can you not lift a piece of underwear to scan an area? I mean if they're wearing some long johns and/or a corset, then sure cut those thing off. But I feel that people need dignity as much as the next person.

The point is that they are going to get stripped of anything they are still wearing within about 2 minutes of getting into the trauma room. These patients are getting multiple interventions at once in preparation for advanced imaging or surgery. If I bring in a major trauma pt they automatically get a second IV line, intubated if they aren't already, a chest x-ray, a foley cath and possibly a chest tube before leaving the ED.

 

[EMT John]

The point is that they are going to get stripped of anything they are still wearing within about 2 minutes of getting into the trauma room. These patients are getting multiple interventions at once in preparation for advanced imaging or surgery. If I bring in a major trauma pt they automatically get a second IV line, intubated if they aren't already, a chest x-ray, a foley cath and possibly a chest tube before leaving the ED.

All which can be done with underwear on. One snip bra comes off and there's your chest tube and X-ray. People don't need to be paraded around like some kind of show. Dignity is going to lessen stress and provide trust/repor with my pt which in the long run helps the pt. I don't need to continuously stare at someones goodies. I can palpate a chest through a bra and check a pelvice through some chones.

 

[AmeriMedic21]

If i am needing to do a rapid trauma assessment, or if there is significant injury and I need to take a look and the clothing wont move out of the way. I remember I had to splint a guys leg because he had a possible tib/fib fracture, and I had to cut off his cowboy boot because we couldnt get them off either way. He was pissed, but understood that I had to check PMS

 

[EMT John]

If i am needing to do a rapid trauma assessment, or if there is significant injury and I need to take a look and the clothing wont move out of the way. I remember I had to splint a guys leg because he had a possible tib/fib fracture, and I had to cut off his cowboy boot because we couldnt get them off either way. He was pissed, but understood that I had to check PMS

I know what you mean. I cut off I guys brand new leather riding jacket, easily $500 along with his pants and boots. But you gotta do what you gotta do. They guy was very upset like you said but he got over it. If you don't want your nice things cut up don't lay down your bike. -_-

 

[Handsome Robb]

If i am needing to do a rapid trauma assessment, or if there is significant injury and I need to take a look and the clothing wont move out of the way. I remember I had to splint a guys leg because he had a possible tib/fib fracture, and I had to cut off his cowboy boot because we couldnt get them off either way. He was pissed, but understood that I had to check PMS

There's still no reason to cut away someone's underwear or bra. You can easily look around those items. The person is going to be anxious and upset already if they are in a situation where you are making them "trauma naked", if they are awake. Personally I like to try to lower my patient's anxiety levels rather than raise them. Making them totally naked, especially women, around a bunch of firefighters, who are generally men, is counter productive to my goal.

Aidey I agree with you on everything else. I'll nab a second line, intubate them if appropriate and it's possible since we don't carry RSI meds.

 

[mycrofft]

This thread has remained remarkably subdued and professional, versus the usual we've had in the past.h34r:

 

[Akulahawk]

If I have to strip a patient, I'm going to do it by however and whatever means necessary. That doesn't mean that I'm going to expose the patient to the world unnecessarily. One snip and a bra opens to expose the full anterior chest. Two more snips and it stays on the gurney... Two snips of the underwear and I can get at the entire pelvis and perineum. That doesn't mean that I'm going to just leave the patient that way. It means that I can flip the fabric back up and cover those parts and provide for modesty as much as possible.

One trauma patient I had, I'd stripped him down to his underwear. Had I not snipped off that too, and exposed him completely, I would have missed that his scrotum was quite enlarged, full of blood. That event would not have been good...

 

[Bosco578]

Aside from various trauma that requires exposure,cardiac arrest pt's get there shirts/jacket/bra cut.

 

[Akulahawk]

This thread has remained remarkably subdued and professional, versus the usual we've had in the past.h34r:

You have no idea how much this has me worried... a sign of the apocalypse??? :rofl:

Just kidding... back to our regularly scheduled discussion about the Trauma "Strip & Flip"

 

[Handsome Robb]

Aside from various trauma that requires exposure,cardiac arrest pt's get there shirts/jacket/bra cut.

That's a different situation all together. That's a situation where you need to have access to the chest. If we are in a public place I'm enlisting bystanders or fire to hold blankets up to give us our privacy. Another option is a towel as well. expose them find your landmarks, place your pads and in my case the Philips qCPR puck then drape a small towel over their breasts and continue what we are doing. Our pucks have the screen on them but the monitor still displays the CPR display under the rhythm display so they can use that. The security services here at the casinos have temporary "walls" they bring out when we are working an arrest in a public place on their property. Well they are supposed to bring them out. If they are too lazy to bring them they are getting stuck holding up blankets. Plus I can hang my IV bag from them as well

 

[Akulahawk]

That's a different situation all together. That's a situation where you need to have access to the chest. If we are in a public place I'm enlisting bystanders or fire to hold blankets up to give us our privacy. The security services here at the casinos have temporary "walls" they bring out when we are working an arrest in a public place on their property. Well they are supposed to bring them out. If they are too lazy to bring them they are getting stuck holding up blankets. Plus I can hang my IV bag from them as well

I call that the EMT/firefighter/bystander IV pole. They're wonderful!

 

[Handsome Robb]

I call that the EMT/firefighter/bystander IV pole. They're wonderful!

Yes they are! I never subject my partner to it though. I need their hands free and generally if you do it to a firefighter here they will find a bystander to pawn it off on. I did have a captain do it for me once though. I rested the bag with the pressure infuser on the top of a dresser then the next time I turned around the captain was holding the bag and standing on a chair. Talk about a great effort! I always feel weird "ordering" around firefighters and coworkers when I'm wearing my spiffy white intern shirt. I've found that please and thank you go a long way.

The one downside to the bystander IV pole is that it can be a pretty traumatizing experience for the bystander. Especially if they have never seen something like it before. I've noticed in all the codes I have run there is usually one bystander who is overly interested and willing to help.

Unfortunately in my short career I've run or been a part of more than my fair share of them.

 

[Akulahawk]

Yes they are! I never subject my partner to it though. I need their hands free and generally if you do it to a firefighter here they will find a bystander to pawn it off on. I did have a captain do it for me once though. I rested the bag with the pressure infuser on the top of a dresser then the next time I turned around the captain was holding the bag and standing on a chair. Talk about a great effort! I always feel weird "ordering" around firefighters and coworkers when I'm wearing my spiffy white intern shirt. I've found that please and thank you go a long way.

The one downside to the bystander IV pole is that it can be a pretty traumatizing experience for the bystander. Especially if they have never seen something like it before. I've noticed in all the codes I have run there is usually one bystander who is overly interested and willing to help.

Unfortunately in my short career I've run or been a part of more than my fair share of them.

Indeed it does! The Firefighters I interned with would absolutely bend over backward for me as long as I asked them to. This includes Captains, Battalion Chiefs... It is just amazing how willing people are to help you out when you're just nice to them. Never forget the "thank you" because it's just the right thing to do. Eventually even the other Firefighters at other stations were just as willing to help me out because they'd heard that I wasn't a jerk... Believe me, word got around really fast! It's a very small world in EMS.

 

[zmedic]

So not say that the bra has to come off in the ambulance, but it's coming off in the trauma room. I need access to that area for:

1: My FAST ultrasound
2: Monitor leads
3: Possible 12 lead

If they are sick there might be the need for:
4: Chest tubes
5: Pericardiocentesis

If they are coming into the trauma room you are saying "they are sick enough that they may need surgery so

6: Pre-op patients need their bra off.

I also need to see everything, and see it quick. I need to look between the butt cheeks, everywhere. Probably am putting in a foley. Also i'd point out:

7: If they are damp, the cotton bra/underwear is going to make them colder.

So like I said, it doesn't have to happen in the rig, but it's happening in the trauma bay. And at least cut the shirt so I can start my IVs and get vitals as soon as they hit the trauma bay.

Also, move the darn patient to the bed, then start talking. Or do it at the same time. But when the medic sits there talking while 20 people are waiting for the patient to be moved to start treating it makes us a bit nuts.

 

[DrParasite]

Also, move the darn patient to the bed, then start talking. Or do it at the same time. But when the medic sits there talking while 20 people are waiting for the patient to be moved to start treating it makes us a bit nuts.

oddly enough, our trauma attending wanted the exact opposite. He insisted a report be given by EMS to the trauma team, and only after everyone had no questions, could we transfer the patient to the trauma bed, and they would go to work. apparently the doctors and nurses wouldn't pay attention to the EMS report if we transferred the patient to the bed and then get a report.

Would drive me nuts, because it delayed our turnaround time, and it delayed my cleaning and stocking time, which kept me in the ER longer that an EMS crew should, especially with calls holding (and no, management frowns on using mutual aid).

I would rather drop the patient off, take the cot and start cleaning and restocking, while my partner gives the report and let the trauma team go to work. but the trauma MD's don't want it that way, so we did what they said.

As for the OP's question, on a sick/critical trauma patient, everything comes off, and they patient is covered with a sheet. on a non-sick trauma patient, leave underwear on assuming it doesn't interfere with assessment. if it interferes, than off it goes.

Also, if they can't take it off themselves, or it hurts too much for them to take it off, and I need it off, than snip snip it goes. also remember, just because you are helping the patient out by not cutting their clothes in the truck doesn't mean the ER won't snip it all off when they get onto the hospital bed.

 

[NomadicMedic]

My rule of thumb is this: a "serious" multisystem trauma gets stripped and covered with blankets once I have everything done. We're bringing in patients that are borderline hypothermic... While I need them naked, they don't need to be chilled to the bone.

 

[Sasha]

Yes they are! I never subject my partner to it though. I need their hands free and generally if you do it to a firefighter here they will find a bystander to pawn it off on. I did have a captain do it for me once though. I rested the bag with the pressure infuser on the top of a dresser then the next time I turned around the captain was holding the bag and standing on a chair. Talk about a great effort! I always feel weird "ordering" around firefighters and coworkers when I'm wearing my spiffy white intern shirt. I've found that please and thank you go a long way.

The one downside to the bystander IV pole is that it can be a pretty traumatizing experience for the bystander. Especially if they have never seen something like it before. I've noticed in all the codes I have run there is usually one bystander who is overly interested and willing to help.

Unfortunately in my short career I've run or been a part of more than my fair share of them.

I keep getting stuck on with a stretcher with a broken IV pole. My regular partners know what I want when I tell them to "Be tall" and will pick up the bag and hold it up themselves. I've trained them very well >

That being said, "ordering" someone around is wrong. I always ask "Can you please" "will you please" first. If they are being difficult then it goes to "I need you to do this now." "Do this, do that, go get that" etc.

 

[EMT John]

If I have to strip a patient, I'm going to do it by however and whatever means necessary. That doesn't mean that I'm going to expose the patient to the world unnecessarily. One snip and a bra opens to expose the full anterior chest. Two more snips and it stays on the gurney... Two snips of the underwear and I can get at the entire pelvis and perineum. That doesn't mean that I'm going to just leave the patient that way. It means that I can flip the fabric back up and cover those parts and provide for modesty as much as possible.

One trauma patient I had, I'd stripped him down to his underwear. Had I not snipped off that too, and exposed him completely, I would have missed that his scrotum was quite enlarged, full of blood. That event would not have been good...

So would you cut your window blinds down to look outside? Or move it to the side, see if anything is there and move on? Same goes for underwear, can you not just move them to the side and take a look? Bra's are small enough and tight fitting to work around and keep the pt comfortable in a trauma. I think if I go on its going to be beating a dead horse.

 

[Handsome Robb]

What it comes down to is everyone has their own style of doing things. There's a thousand ways to get from A to B and as long as you are efficient and not causing further harm to the patient it doesn't really matter as long as you get to the end goal.

 

[mycrofft]

Agreed, and kudos for the Please and Thank You department.

And NOWHERE did I read of anyone slashing off the clothes with their knife, V-blade, etc!