Should all patients have clothing removed?

[spenac]

It bothers me that 1st of all the child died unfortunately, and also 2 medic lost there jobs. I do not think that all patients should have their clothes due to common sense and privacy. I can not say what I would of done in this situation without all the facts. Did the child go to the hospital? If so than, the medics would not be responsible by what I can tell. I work at an ER, so I work in the hospital base of ER. It would be up to the doctor to diagnose the patients condition and do the appropriate exam.

I hope that these medics will or can appeal to get their jobs back. It doesn't sound to me that they are responsible for the incident by going by what little I know.

Again this was a scenario that was brought up on another site, to the best of my knowledge not real. All partys that have witnessed or suspect child abuse are required to report it not just the doctors at least in Texas. Again a broken humerus should make a reasonably educated medic want to check that no other injuries occurred when you consider the amount of energy to break it. Had they examined the patient appropriately for type of injury the child had they would have seen signs of abuse and thus would have had to report it. First they failed to do proper exam then because of their improper action they failed to find or report possible abuse leading to childs death.

[CBEMT]

Nope but you go to court the lawyers use anything at their hands to nail you for violating standard of care.

Ohhh I get it now. Someone has lawyerphobia.

Headache = eclampsia

Not counting pre-eclampsia, there are about 8 risk factors and nearly as many symptoms of eclampsia. You want to field-strip your patient based on one? Suffice to say, if you ever work with me, I'll be teching all female patients, thank you very much. :?

When I said it got reamed for it. But I believe in it.

Riiiiiiight......... :roll:

[katbemeEMT-B]

I too am bothered by the fact that 2 medics lost their jobs over this. I'm not sure if it's the same all over, but in our area if a medic suspects abuse they report it the medical director who decides if further investigation is needed. My other thought is that this child I'm sure had been seen by doctors numerous times. Why did they not report the abuse. Whether these two medics stripped this kid or not and did a further exam should not be a factor. We are there to treat the chief complaint. If it happens to be a broken arm and the child wasn't complaining of pain any place else, why would you waste time doing a detailed exam. Unless of course they were told that it happened as a result of a severe moi (ex.: fell from an extreme height, hit by a vehicle, fell off a skate board). You get the point. I have been in this situation, a child who broke his arm. It apparently happened at wrestling practice. We had no reason to believe other wise. We did not strip him either. We stabalized the arm, packaged him for transport, and off we went. We left it up to the hospital to remove any clothing as we did not want to compromise the arm any further.

Removal of clothing truly is a case by case situation. If you use the brain that you are given it should be a no brainer.

[spenac]

Ohhh I get it now. Someone has lawyerphobia.

Not counting pre-eclampsia, there are about 8 risk factors and nearly as many symptoms of eclampsia. You want to field-strip your patient based on one? Suffice to say, if you ever work with me, I'll be teching all female patients, thank you very much. :?

Riiiiiiight......... :roll:

Dude you miss the point in my area almost every female patient we get from 11 up to even close to 50 are OB active labor. Did you not catch the "in my part of the world" statement. We get dispatched headache and end up delivering. We get dispatched stomach ache deliver baby and have the little girl claiming it's not her's, get dispatched sob deliver baby. Would I think every headache is eclampsia, no, just based on complete comment OB with headache would need to rule out eclampsia, I should have gone more in depth sorry. I have been around some legal issues and the thing I learned, CYA, phobia nope. Gladly let you deliver all the babys if your here, gets messy and slippery at times back there.

[spenac]

I too am bothered by the fact that 2 medics lost their jobs over this. I'm not sure if it's the same all over, but in our area if a medic suspects abuse they report it the medical director who decides if further investigation is needed. My other thought is that this child I'm sure had been seen by doctors numerous times. Why did they not report the abuse. Whether these two medics stripped this kid or not and did a further exam should not be a factor. We are there to treat the chief complaint. If it happens to be a broken arm and the child wasn't complaining of pain any place else, why would you waste time doing a detailed exam. Unless of course they were told that it happened as a result of a severe moi (ex.: fell from an extreme height, hit by a vehicle, fell off a skate board). You get the point. I have been in this situation, a child who broke his arm. It apparently happened at wrestling practice. We had no reason to believe other wise. We did not strip him either. We stabalized the arm, packaged him for transport, and off we went. We left it up to the hospital to remove any clothing as we did not want to compromise the arm any further.

Removal of clothing truly is a case by case situation. If you use the brain that you are given it should be a no brainer.

Humerus break requires serious moi in almost all cases, therefore should move you to do a more detailed exam. As far as removing clothes w/o moving arm use shears. By only treating cc we then would give aspirin to anybody with a headache only to let the doc find the CVA. We must avoid getting so focused we miss the big picture. Many times what the patients cc is, is actually the least critical problem. Think about trauma, usually the pain they complain about is not at the most serious injury locations. I guess because I spend more than an hour with each patient I have developed the mindset that there may be more than meets the eye and I proceed accordingly. Again in Texas anyone that suspects abuse must file a report.

[Dustdevil]

Humerus break requires serious moi in almost all cases, therefore should move you to do a more detailed exam.

Yeah, well I am glad you have an x-ray machine in your ambulance, but most of us don't.

And simple palpation will tell you if there is thoracic wall injury without stripping your patient, so that is not necessary.

As for this "cultural sensitivity" nonsense, gimme a break. Somali mama would have never made it into the back of my ambulance in the first place. She would have been staring at a locked door, or better yet, the back seat of a police car. And she is not my patient, so she can just take a flying screw with her yapping. You want cultural medicine, go back where you came from. I don't travel the world expecting other cultures to conform to my sensitivities. Those that come to America should respect OUR culture the same as I do when I visit theirs.

[spenac]

Yeah, well I am glad you have an x-ray machine in your ambulance, but most of us don't.

And simple palpation will tell you if there is thoracic wall injury without stripping your patient, so that is not necessary.

As for this "cultural sensitivity" nonsense, gimme a break. Somali mama would have never made it into the back of my ambulance in the first place. She would have been staring at a locked door, or better yet, the back seat of a police car. And she is not my patient, so she can just take a flying screw with her yapping. You want cultural medicine, go back where you came from. I don't travel the world expecting other cultures to conform to my sensitivities. Those that come to America should respect OUR culture the same as I do when I visit theirs.

You used the term "common sense" earlier dust well it doesn't take an x-ray to tell you somethings broke everytime sometimes common sense does. Also to properly exam a potential injury site takes touch as well as sight. I've known people with broken ribs (per doc later) that did not even flinch when palpated, but on visual you could see discoloration so I at least knew they had an injury even if they denied pain. I would still argue that even with it being a potential broken humerus would cause me to look beyond the arm and at least check shoulder, collar bone visually as well as palpated. By exposing for this signs of abuse if there would be seen.

Dust if you throw out peoples beliefs then you go against what founded this country religious freedom. We need to work with others beliefs if we want them to respect ours. Don't have to agree with them but should respect them.

[Dustdevil]

Dust if you throw out peoples beliefs then you go against what founded this country religious freedom. We need to work with others beliefs if we want them to respect ours. Don't have to agree with them but should respect them.

Part of religious freedom is my freedom to disregard other's stupid beliefs.

I have to neither agree with nor respect them. That is my freedom.

And besides, why do I have to respect them if they don't respect me? I was here first. This is MY home. I would not go to their home and tell them how to run their lives (although, I do recognise that a lot of ugly Americans DO do that).

Religion and medicine don't mix. You don't want medical care? Fine. Sign here, and I am out of here. You can walk your Somali arse to whatever witch doctor you want to treat you without exposing you.

[spenac]

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

Personally I see several benefits of it. Not miss something that could affect your choice of treatment for one. A possible side effect might be people deciding not to use ambulance for a Taxi, a big plus. Nurses would appreciate not having to place them in a gown.

[spenac]

Part of religious freedom is my freedom to disregard other's stupid beliefs.

I have to neither agree with nor respect them. That is my freedom.

And besides, why do I have to respect them if they don't respect me? I was here first. This is MY home. I would not go to their home and tell them how to run their lives (although, I do recognise that a lot of ugly Americans DO do that).

Religion and medicine don't mix. You don't want medical care? Fine. Sign here, and I am out of here. You can walk your Somali arse to whatever witch doctor you want to treat you without exposing you.

So dust if you want to refuse one type of treatment because of your beliefs I should tell you to get the hell off my ambulance and not treat you? Let's say your religion says bandaids are bad and you come on my ambulance with a small cut, while I should kick you off for wasting my time with a small cut, I should not kick you off for your beliefs, I should give you a 2x2 tell you to keep pressure on it and then deny transport as is not an emergency. If a person needs treatment and wants treatment but has different beliefs I should do my best to do what I can w/o harming the person physically or in my opinion more importantly spiritually. Treat the whole person!!!!!!!!!!!!!!!!!!!!!!!!