Why we cut clothes off

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WoodyPN

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I work as tech at a Level III Trauma Center covering four counties mostly city/suburban. Last night(..as I was going on my 18th hour of work) we get informed of 4 traumas inbound. Two Priority 1s, category A, a Priority 1 cat B, and a Priority 2 cat C.

We have 4 trauma rooms. Amazingly, this happened right at shift change, so we held nurses, etc etc, and were able to have enough trauma nurses/techs etc. Didnt have enough docs...but thats another story.

Anyway, I jump in Trauma 2, and we get one of the Category As, which has obvious abdomen distention, contusions, etc. His entire left thoracic region feels like rice crispies..first time feeling crepitus. However, he still has his pants on. So I start cutting... and this guy had a (undiscovered by the medic crew) hole in his leg about the size of a quarter which was spurting out blood. I immediately slam my hand down on it of course trying to stop it, but nevertheless, the gentleman did not make it. (Obviously there were other factors/injuries).

The paramedic even said it...thats why everything gets cut off.
 
wow thats amazing, completely exposing the pt is the first thing we learned when we started doing our trauma assessments a couple weeks ago. it makes obvious sense, I wonder why it wasn't done in the field in this case.
 
How could someone miss a serious haemorrhage?
 
I will cut clothes off, life threatening of course. I know providers who just want to use their scissors when the patient could have just removed the clothing for them.

If they can take it off without exacerbating the injury, that's how I do it.

And please don't ever let anyone cut off a down coat, in the back of an ambulance, those who have seen it know what im talking about, think chicken coop and hand grenade.
 
WoodyPN said:
mostly city/suburban.
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Answered your question right there.



Coming from rural medicine to urban medicine myself, it's a totally different ballgame with just minutes to transport as opposed to an hour where you have time to be thorough.


Sure, a full body exam should be tried to be accomplished, but if you have a major trauma, as part of an 'MCI', with pressing issues such as airway control or other severe upper body injuries, and transports of just minutes, I can see how a leg wound could be missed. You said he was 'Pri 1 Cat A" which I can only assume, since we don't know your lingo, means he's screwed and has a whole load of crap going on... right? Yes, you should try to make your patients naked, but like we try to stress to nurses that don't work out in the field, sometimes you don't have time to get everything done that you want to.
 
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Oh yes, Priority 1 trauma category A is as jacked up as it gets.

Also, I completely understand how it is in the field. I have worked bad car accidents with the very same medic before. Im not critical of him, I just decided to share because it was a learning experience for me.
 
cause i wanna see whats underneath ;)
 
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cant believe they missed that, all my MVC patients being transported get clothes cut off, as well as some falls etc, no need to cut them off on every call but that is pretty unacceptable
 
I need more experience with trauma. I've only been an EMT for 5 or 6 months now and I've only gotten a few modified traumas of car accidents under 40 mph.-_-
 
Linuss said:
Answered your question right there.



Coming from rural medicine to urban medicine myself, it's a totally different ballgame with just minutes to transport as opposed to an hour where you have time to be thorough.


Sure, a full body exam should be tried to be accomplished, but if you have a major trauma, as part of an 'MCI', with pressing issues such as airway control or other severe upper body injuries, and transports of just minutes, I can see how a leg wound could be missed. You said he was 'Pri 1 Cat A" which I can only assume, since we don't know your lingo, means he's screwed and has a whole load of crap going on... right? Yes, you should try to make your patients naked, but like we try to stress to nurses that don't work out in the field, sometimes you don't have time to get everything done that you want to.
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I agree. We do not delay transport for everything to be done. We get them into the closest ER or trauma ctr which is often very close. And there is still a ton of stuff I am supposed to have done but did not get around to.

I once had a pedestrian struck right outside an ER. We board and collared and went inside. We didn't even load into the rig. Not much was done prehospital.
 
traumaluv2011 said:
I need more experience with trauma. I've only been an EMT for 5 or 6 months now and I've only gotten a few modified traumas of car accidents under 40 mph.-_-
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Er, modified? In what way? :wacko:
 
Anything that gets in the way of a complete, hands-on assessment of trauma victims -- especially if unconscious or disoriented -- gets removed. That includes the neglectful medic.
 
caox3 said:
and please don't ever let anyone cut off a down coat, in the back of an ambulance, those who have seen it know what im talking about, think chicken coop and hand grenade.
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omg lmao!!
 
Cajun posted a thread about a lawsuit due to "overexposure"

If I recall (pressed for time at the moment) it was a bogus attempt by soon to be ex husband to get money, but it is an interesting factor. How are we at cutting off clothes:
1. Female Muslim (wearing evident costume or tells you so) in a middle eastern country (or neighborhood)?
2. IT's raining and 15 deg F outside.
3. etc

Sometimes it will need to be done in the ambulance.

PS: Somewhere in the back pages I describe my unnecessarily cutting off a guy's shirt...:blush:
 
mycrofft said:
If I recall (pressed for time at the moment) it was a bogus attempt by soon to be ex husband to get money, but it is an interesting factor. How are we at cutting off clothes:
1. Female Muslim (wearing evident costume or tells you so) in a middle eastern country (or neighborhood)?
2. IT's raining and 15 deg F outside.
3. etc

Sometimes it will need to be done in the ambulance.

PS: Somewhere in the back pages I describe my unnecessarily cutting off a guy's shirt...:blush:
Click to expand...

If the clothes need to be cut off, they need to be cut off, but whatever happens, the precipitation is going to be less than wet at 15 degrees F.

Blankets, blankets and more blankets. This time of year, we have at least 10 stashed all over the ambulance.
 
Roger the precip

Used to drive a rescue truck and civilian ambulances in freezing rain. :ph34r:

In a mass-cal you will do a cursory for rough triage, start moving people out and treat as much as you can enroute, having addressed anything that will kill them before they reach the rig first or triaged them "expectant" and moved on. Length of distance to load or stage at the ambulance then transport time will help determine how much time per pt you would spend using the ground as an exam table.
 
CAOX3 said:
I will cut clothes off, life threatening of course. I know providers who just want to use their scissors when the patient could have just removed the clothing for them.

If they can take it off without exacerbating the injury, that's how I do it.

And please don't ever let anyone cut off a down coat, in the back of an ambulance, those who have seen it know what im talking about, think chicken coop and hand grenade.
Click to expand...

This is true. Your truck will look like a snow globe! However, if you're cutting clothes off, you're not playing around.
 
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