Rules for exposing a patient?

[musicislife]

I am confused, because they never touched upon this in my class, nor is it in my book. Can anyone point me to some further reading on the subject? For instance, I am unsure wether or not to expose a patient on the side of a highway or some other public place. What are the general rules, and is there further reading online? I suppose (lets say in a street for a car accident) I would inform the conscious patient, boot any LEOs, firemen (if possible) and nosy bystanders away from the pt, use tarps or sheets held up by others to hide if possible, expose one area at a time then cover up by taping it with a couple pieces of tape, allowing for easy re exposure should a person with higher level care need it, and document the exposure of each area thouroughly. Am I correct here in my thinking?

Edited June 1, 2012 by musicislife

[DwayneEMTP]

Your thinking is kind, but in a patient that you need to expose completely you won't want to take that kind of time.

I've had issues because I want to expose seriously wounded patients before the straps go on as doing it after takes much longer plus can cause a lot more manipulation of their body at a time when you're trying to keep them still. Some people get pissed because I expose many, in fact most, seriously injured patients where I find them. I know that others like to put them in the ambulance first. I'm just not a good enough medic that I want to let someone bleed for another 4 minutes.

With practice you'll find that you can cut the clothes in a way that allows you to see one part of the body and then drag the cut clothes back over it. But boobs and crotches is my only real concern. And they're not a huge concern when time is important.

In non critical patients, say, a guy wrecked his mountain bike and skidded down the street on one leg, you may choose to only expose that leg at first. Someone in a rollover accident you'll nearly always want to expose completely.

Take them down to their underwear, bra/panties, cover them with a sheet when you can, and then make sure that you see inside of the undergarments when you have privacy, or immediately if you see blood in/on them.

The rule is "Life over limb" and certainly "Life over modesty." I saw somewhere, probably here that a big cause of traumatic death is undiscovered injury. I've no idea if it's true, but I'm kind of a freak for getting traumatic patients naked and I've found wounds in some very unexpected places.

The short answer to your question is that there is no one rule. As long as you worry about life and doing what's best for your patient first, and let all of the other crap sort itself out later, then you won't go far wrong.

In the scenario presented above if the person is in the street secondary to being ejected, I can guarantee you that while Fire gets the cot and board and my partner sets up for a trauma in the back of the ambulance I'm going to get the patient naked. Ejections are almost always really ugly on hard surfaces. Fire will, if they're not idiots, bring a sheet and while they are boarding, I'll be assessing for life threats and about that time we'll cover the patient with a sheet...OVER the straps so that I can get access anywhere that I want.

And for the record? Everyone peeks at naked people. It's all part of being a sexual being. There's no shame in looking, and even being impressed, as long as the thought is fleeting and you get back to work.

I know you didn't ask, but everyone wonders, and too many feel guilty for being human. The first time you cut the clothes off of a Ms. Universe type body, or a penis that rightfully belongs on a pony, it will get your attention. No harm there...Just sayin'...

Good question!

Maybe what you could do is present some more scenarios that you think might be confusing and allow others to give specific opinions. But you need to be more specific about patient presentation, because nearly all answers will be based on that.

Plus, presenting scenarios is wicked good for creating logic trees in the newly developing EMS part of your brain. Just a thought...

[island emt]

To add to what dwayne said If you need to see then do it.

Don't expect that a fall from standing height with a broken ankle gives justification to cut a woman's clothes off exposing her for the public to see .

Use common sense!

If your gut says trauma center then they need to be exposed , & examined from head to toe.

Medical pt's probably not so much.

Some things will scare the bejesus out of you when exposed. :-}

Dwayne has this small pony fixation due to being in PNG among the little people hung like horses.

[Just Plain Ruff]

My thoughts are this, when in doubt expose. Multi system trauma patients almost always equal naked trauma patient but they nearly always will arrive in the ER covered with some sort of sheet.

It's not right to wheel them in through the ER door totally naked unless you are doing CPR on them. Use common sense.

As for other patients, once you have exposed and evaluated the area, then by all means cover them because you have removed their source of warmth even on a hot day. Imagine a airconditioner on a naked or nearly naked body with cold IV fluids running in, you can get cold quickly.

Expose, look, examine, cover, repeat on other part of body.

And remember this cardinal rule, If you were the patient, think about how you would like to be treated in the same situation by you as a medic or emt!!!!!

[Kiwiology]

You should appropriately expose your patient to examine them, it is very important to preserve their dignity, keep them warm, the wonders of the high tech ambo blanket or drawer sheet!

[Eydawn]

If the fit has hit the shan, nekkid is the least of their worries. Strip, flip, thorough exam, then cover back up... if you've got nosy bystanders with cell phone cameras out, feel free to have the nearest free responder go over to tell them off and warn that their phones may be confiscated in the event of a criminal investigation surrounding the event...

Wendy

CO RN-ADN Student

[Bieber]

Like Dwayne and others have already said, life comes before dignity. Do what you feel you need to do when you feel you need to do it. Tarps would be nice, but honestly just expose them if you need to. Alternatively you can unstrap them from the cot in the back of the ambulance to fully expose them--as long as you remember to strap them back in before you guys start transporting. Unfortunately as long as we continue to use death--I mean spine--boards, straps are going to have to be worked around to deliver patient care.

[musicislife]

what about medical patients (again, no advice in my book, couldnt find much online either)

[Bieber]

In medical patients there's not usually as great a need to expose the patient as in trauma patients, but again, if you need to do it just do it.

[paramedicmike]

Very well done, Grasshopper. Good question, too.

You've gotten many good answers here. For medical patients, as has been noted, there will be very little reason to fully expose a patient. There may be cause to partially expose a patient. Use some common sense and that'll take you far.

With trauma patients, the game changes a bit. As has been noted you will have to expose your patient. For an isolated extremity trauma that may require only exposing that extremity. For a multisystem trauma that may mean making them trauma naked. Again, use some common sense here. While you know you will have to expose your patient there are times when it may be better to move the patient to the ambulance before cutting his/her clothes off. Then again, there may be times when you have to do it where you find them. This is something that you'll learn as you go.

There's a lot of truth to the idea of "life before dignity". Please don't, however, use this as an excuse to completely disregard the patient's dignity. It seems that there are many times when people do things simply because they can and not because it's necessary. As health care providers we get used to seeing people naked. We sometimes forget to think that not everyone else is used to seeing people naked. So while it's not a big deal to us to cut people's clothes off and make them naked it *is* a big deal to the patient, family members and possibly bystanders who have nothing better to do than gawk at the naked lady on your stretcher.

We have a job to do. Sometimes it's even an important job to do. Part of that job includes protecting the patient's dignity as best as possible in an effort to treat him/her even when it requires we make them naked in the process.