Opinion Wanted

[spenac]

Another question did you strip the patient? If not you did not do a good assessment. This should have been done while waiting. A sheet held up gives plenty of privacy. After strip, and board cover them up.

[EMS Solutions]

Well James now you went and did it.

Now while I think the patient should have been ready to go upon arrival of the second ambulance.

Strip the patient?? Let's be real here. Yes expose as needed. But a stable patient I dont think needs to be stripped out in the open, I dont care how many sheets your holding up.

Of course you can do it, and you can justify it as "proper pt care" But

Would the same person with the same training in the same situation do it?

I guess it would depend on the age, weight and + Jessica Alba findings.

If she was too young we could wind up in the EKG thread

Well, have fun on your next MVA second guessing yourself.

[spenac]

First rule of EMS safety.

Second rule ABC.

Third rule expose. If you don't look you are going to miss it. Maybe not a big deal 10 minutes from hospital, but 90 miles you miss something things can change. Strip em and flip em, in other words expose and look for problems front and back. Yes somebody twists ankle just expose ankle, but this was an accident with at least one major injury since helicopter coming in, she needs exposed, failure to do so is bad medicine.

Is this patient actually stable? Perhaps she's compensating. Perhaps she has head trauma causing her actions.

[spenac]

I guess it would depend on the age, weight and + Jessica Alba findings. If she was too young we could wind up in the EKG thread

The reason people get in trouble is they are selective. If you follow same method you are covered. If you strip the fat ugly old guy for same type of accident you are not in trouble for stripping the 16 year old cheerleader.

Strip the patient. I have found bruising that ended up being deeper than we thought on a stable slow speed crash that ended up being ruptured spleen. Patient had no tenderness, but because of marks on abdomen and chest I monitored close and was able to stay ahead of shock.

[medic001918]

Strip the patient?? Let's be real here. Yes expose as needed. But a stable patient I dont think needs to be stripped out in the open, I dont care how many sheets your holding up.

Yup, let's be real here. This a motor vehicle accident involving air transport, so assuming the potential for life threatening injury. And should this patient be stripped, sure. Why not? You can strip the patient and look while providing privacy. I cut up the pant legs, leaving the hip region in place to provide for privacy. It allows me to look at what I need to, while providing for privacy. And either way, you can still provide a much better assessment of a trauma patient while they are on a backboard than you can while they are sitting in vehicle.

Shane

NREMT-P

[EMS Solutions]

Expose as needed. Round and round we go.

Everyone considered this patient stable. Now that a new comment gets made going against textbook treatment, she may be compensating or have a hidden injury.

Listen, I'm not saying to not expose and look at potential injuries. But certainly not on a roadway, unless of course the situation calls for that. So far this one does not.

She's been in the car for at least 10 mins, with a life saving collar on. All of a sudden everyone wants to take her clothes off.

Maybe she is compensating, maybe she is a drama queen and computing her lawsuit.

I wasn't there. However, those of you saying you would strip her down and use sheets to protect her privacy. Good for you. Let me know when your court date is.

[medic001918]

She's been in the car for at least 10 mins, with a life saving collar on. All of a sudden everyone wants to take her clothes off.

You're right, she has been in the car for 10 minutes with a life saving collar on. And she should have been removed prior (stable or not) to expedite transport and to perform a proper assessment (exposed or unexposed).

I wasn't there. However, those of you saying you would strip her down and use sheets to protect her privacy. Good for you. Let me know when your court date is.

I'd be willing to bet that in the case of exposing trauma cases, the court date comes sooner for those who don't expose than those who do. You can always err on the side of caution (and the patient) in exposing and justify it. Not exposing, however could easily be exposed as negligent in patient care. You pick which side you'd rather defend...the side of doing more in terms of assessing a patient, or the side of not doing enough of an assessment. I know where I would rather be.

Now, I'm not saying that I would have completely exposed this patient making them completely naked in the street. But a quick cut up the pant legs and the shirt to expose and check for injuries in an accident that warranted air transport isn't too much of a stretch. Patient assessment can be justified more easily than patient privacy. Especially if you were cautious in how it was done.

The bigger issue here is still that nothing was done for this patient while they were waiting for ALS to show up. Where is the justification in that?

Shane

NREMT-P

[MedicT]

As my experience as a medic, I probably would have expected full packaging upon my arrival. I am in Fl, so its hot here too, but not really safe to leave a car runing s/p a moderate mvc.

[EMS Solutions]

OK, Uncle Uncle

I agree that the patient should have been removed from the vehicle prior to the second ambulance getting there.

I agree that exposure of key areas as needed for this patient should have been done. However, I would prefer to do that in the ambulance with the patient supine on a board.

Not on the ground or inside of a car with some whacker holding a sheet to keep prying eyes out.

The thing is, if the patient was being extricated as she should have been while the ambulance was enroute. Then according to the ETA she would have been removed about the time of arrival and put in the ambulance for all this exposing to be done anyway.

Now a different scenario may have warranted doing some exposing on scene. But in this one I don't feel it was.

To just throw that in as a post to pick away at the scenario and what went on is just being a backseat driver.

I don't think that a patient as described needs a strip and flip, scratch N' sniff , pull my finger or whatever out in a roadway.

Of course her condition could have been this or that, the airbag could have released, the car may have exploded etc etc etc etc.

As the arriving ambulance ultimately responsible for patient care , I am going to do it over again anyway. I don't care what you did before I got there as far as exam goes. Just get them packaged and ready, so it won't delay my mastery of IV therapy for trauma patients.

With that said, I blame James for all this. I was just having a relaxing Friday.

[spenac]

The thing is, if the patient was being extricated as she should have been while the ambulance was enroute. Then according to the ETA she would have been removed about the time of arrival and put in the ambulance for all this exposing to be done anyway.

With that said, I blame James for all this. I was just having a relaxing Friday.

Did you expose at least her back prior to boarding? If not you have not done a complete exam. Are you going to take her off the board to check her back in the ambulance? Not a wise thing to do. Expose, examine, cover, not hard to do.

Wow James are you promoting Friday night fights? :twisted: