Should all patients have clothing removed?

[spenac]

Guys lets get back to what the original post was asking, Should all patients be stripped?

[katbemeEMT-B]

In my area we have relatively short transport times. The longest being 16 - 20 minutes. Most are about 7 minutes. If we had to spend the time disrobing a patient for a broken arm we would not be able to perform any other procedures such as vitals. Especially with a child who is scared to death and needs the extra attention to help keep them calm. When we get the patient to the hospital we are there to help move the patient to the bed, disrobe them and get them into a gown and if the child wants, stay with him for a short time to assure him that things will be okay to help him to stay calm.

That's not saying we don't ever disrobe a patient. We recently had a victim from an mva. She was 7 - 8 months pregnant and of course spoke no English. We had no idea where her pain was. Because she was a restrained front seat passenger with a deployed airbag, the first thing we did was to cut her clothes off and perform an exam. This was not an ideal situation as we also had a male patient from the other car. We did our best to keep her covered but we also kept another EMT strategically placed between them so he wasn't able to see anything. Upon our exam we discovered she had several broken ribs which as we watched the baby pushed them out of alignment. It was kind of freaky yet still neat to see. At least we knew the baby was still active.

This is why I say it is completely situational. There are so many variances that it becomes what the medic or EMT sees as the proper care for that individual.

Another example is a 9yr old injured at a motocross race. He was obviously bleeding from the face as he split his face open. As we talked to him he began to complain of sob. We attempted to remove his shirt but this only increased his anxiety causing it to become even more difficult to breath. We made the decision to leave the shirt on and once in the rig lifted it to examine him while also attaching a 12 lead. Upon our exam we observed bruising on the chest and abdomen more than likely from hitting the handlebars of his bike. Although we didn't remove his shirt we were still able to get a visual and treat accordingly while keeping him calm and lowering his level of anxiety.

[EMS_lifer]

No way do you need to strip every patient. Even the fractured arm...Yes, it does take a great force to break that bone, however, it does not necessarily mean they have other injuries. I have transported multiple patients with # arms and they have not had any other injuries. (except injured pride maybe). I had a kid that fell off a bike and broke her humerous.....nothing else. No indication that there was any either....just fell off and landed on her arm. A kid is going to tell you if they have other pain.

All of my patients with "just" a broken arm have ALL come to the ER in ALL of their clothes.

With that being said, if the patient was uncoscious, then yes, I would probably disrobe then. Otherwise you can't tell if there are other injuries. AND if the MOI indicated there may be other injuries, then that is different.

[Chief1C]

Yes, it does take a great force to break that bone, however, it does not necessarily mean they have other injuries.

Oh? What about osteoporosis and other diseases that are oh, so common? Case by case, still have to look. Remember, if it hurts here, look here, here and here.. etc.

[ERDoc]

You absolutely DO NOT have to disrobe every pt. We don't disrobe every pt in the ER. It is purely situational. In the field you guys have to worry about things such as the environment that may make it not practical to disrobe a pt. I'll be damned if I am letting anyone rip my clothes off with half the town watching. Give it a try and I'll slap you with assault. In the scenario presented it is hard to say what would be appropriate since there is little info given. Even with a humerus fx you do not necesarily need to expose further. For any injury you can make an arguement that based on MOI there is for potential for X,Y and Z injuries, but you have to keep it practical and use clinical judgement/common sense (this usually comes with experience).

I would have to disagree with the comments made about disrobing the lady with the headache. You are not going to gain anything from it. Why do you need to disrobe someone with pre-eclampsia? I think someone is just looking to get a few jollies. There is a tell tale sign that will let you know if a pt has eclampsia, we call it a seizure. You could justify disrobing a pt then, but I'm sure there are much more important things to do, such as stop the seizure. Just because a woman is pregnant does not mean she needs to be stripped. Pregnancy is demeaning enough for women with everything they have to go through. Why make it worse for no reason? Even in women with abd pain, why do you need to take off their pants? Can't you just unbotton their pants? Are you planning to do a pelvic exam in the ambulance?

[ERDoc]

A possible side effect might be people deciding not to use ambulance for a Taxi, a big plus.

So you want to violate a person in order to make your job easier?

Nurses would appreciate not having to place them in a gown.

I don't think it takes much for the nurse to hand the pt a gown and say, "Here, put this on. Open side to the back." But, I'm not a nurse so I will defer that to our resident nurses.

[spenac]

So you want to violate a person in order to make your job easier?

I don't think it takes much for the nurse to hand the pt a gown and say, "Here, put this on. Open side to the back." But, I'm not a nurse so I will defer that to our resident nurses.

humor doc humor

[spenac]

You absolutely DO NOT have to disrobe every pt. We don't disrobe every pt in the ER. It is purely situational. In the field you guys have to worry about things such as the environment that may make it not practical to disrobe a pt. I'll be damned if I am letting anyone rip my clothes off with half the town watching. Give it a try and I'll slap you with assault. In the scenario presented it is hard to say what would be appropriate since there is little info given. Even with a humerus fx you do not necesarily need to expose further. For any injury you can make an arguement that based on MOI there is for potential for X,Y and Z injuries, but you have to keep it practical and use clinical judgement/common sense (this usually comes with experience).

I would have to disagree with the comments made about disrobing the lady with the headache. You are not going to gain anything from it. Why do you need to disrobe someone with pre-eclampsia? I think someone is just looking to get a few jollies. There is a tell tale sign that will let you know if a pt has eclampsia, we call it a seizure. You could justify disrobing a pt then, but I'm sure there are much more important things to do, such as stop the seizure. Just because a woman is pregnant does not mean she needs to be stripped. Pregnancy is demeaning enough for women with everything they have to go through. Why make it worse for no reason? Even in women with abd pain, why do you need to take off their pants? Can't you just unbotton their pants? Are you planning to do a pelvic exam in the ambulance?

As far as removing clothes previously mentioned in most cases if done would be done in ambulance, not in public. As far as personally taking clothes off someone only ones I could see would be trauma patients when we cut off clothes. The other patients would be asked to remove clothing and put on gown much like at the hospital. Do we strip every patient, NO. Should we is what I am asking? Just trying to see peoples thoughts about it.

I do not put people in gowns just for headache or abd pain. Doc I mentioned in my area probably would be OB related, of our actual need an ambulance patients at least a third maybe more are OB, if theres any chance they could deliver they are disrobed and hospital gown put on. We transport 90 miles at least, we have areas that take more than an hour to reach and from there around 2.5 hours to the hospital. I have had several deliverys where the woman never even grunted, no real change in vitals, and had we not been doing regular visual exams we would not have been aware they were delivering and had they started delivering in there jeans could have caused more problems. I have raised the sheet and gown on more than one occasion to find a head almost delivered. One thing that amazes me is how quite and still most illegals are during labor. Many have heard stories of babys being taken from them etc and they do not want to upset anybody. I am almost 100% in guessing legal status based on how they act during active labor. Woman here legally usually get loud, want pain meds, cry, etc only to get to hospital and only be dilated at a 1. Illegals usually deny pain, often our only clue is changes on monitor and the changes that are seen during visual exam. But the point of all this is we have have to far to travel and have to be prepared to deliver on all OB's, some take days but others go from 20 minutes apart to delivered in less than a hour, even the doctors can't say how quickly a natural delivery will take.

As far as humerus break my years tell me there is potential for more injurys and should treat as if there are until ruled out. But again my opinion based on my experience and common sense.

Again my way of thinking is based upon knowing I have to stay ahead of my patients condition because I am alone no hospital nearby, no helicopter, no one to take over, IF I MISS SOMETHING PEOPLE DIE, IF I WERE CLOSE TO HOSPITAL MAYBE I COULD LET THE DOCTORS WORRY ABOUT IT BUT NOT AN OPTION HERE. I had a very good EMS professor at a large university here in Texas mention he wishes all his students could ride out with us so they could see the need to think, and realize how what they do can affect a patient. In 10 minutes time many have not even seen the benefit or lack of the treatment they have chosen. As he put it if they screw up or just don't know what to do they are just 10 minutes to hospital and know the doctors will take care of the patient, so not as much pressure. I am not saying we are better, just have a different attitude, different mindset, always looking ahead so if the worst happens ready to take care of it.

Again I realize the things I deal with are different that is why I respond differently than others here. I hope by sharing what I deal with will get others thinking out of their box. I know comments made by city medics have given me lots of things to think about, I have actually started trying some things I have read here, that I had not even given a thought to. If I were 10 minutes to the hospital I see how many things we have to do may not be needed. But I also see things city medics say they do that would not be good to do here.

[Dustdevil]

One thing that amazes me is how quite and still most illegals are during labor. Many have heard stories of babys being taken from them etc and they do not want to upset anybody. I am almost 100% in guessing legal status based on how they act during active labor. Woman here legally usually get loud, want pain meds, cry, etc only to get to hospital and only be dilated at a 1. Illegals usually deny pain, often our only clue is changes on monitor and the changes that are seen during visual exam. But the point of all this is we have have to far to travel and have to be prepared to deliver on all OB's, some take days but others go from 20 minutes apart to delivered in less than a hour, even the doctors can't say how quickly a natural delivery will take.

LMAO! Dude, that is so true!

BTW, there was a previous topic here where the concept of gowning our patients was discussed, or mostly cussed. You might search it for a little more varied input.

[AZCEP]

IF I MISS SOMETHING PEOPLE DIE, IF I WERE CLOSE TO HOSPITAL MAYBE I COULD LET THE DOCTORS WORRY ABOUT IT BUT NOT AN OPTION HERE

Just a bit dramatic there, don't you think? :roll:

With that amount of time you should be able to perform a thorough assessment and still allow for some degree of modesty for your patients. Time/distance is not a determining factor of forcefully disrobing someone. Remove the clothing that is required an no more.

Your OB patient should probably have undergarments removed if they are in active labor. Otherwise it is assault. Potential for injury is a poor excuse for doing anything. Sometimes it is the only reason we have, but that does not make it a good one. Bilateral IV's--could be bleeding internally, spinal precautions--could have a cervical/vertebral fracture.