Should all patients have clothing removed?

[spenac]

You don't expose, you can't see, you can't see you can't document, you can't document you did not assess.

R/r 911

I agree with you here. The Brady paramedic book says to expose to examine chest area of patient for cardiac problems not codes but problems to properly assess, just one of many examples found in brady, mosby, aaos paramedic books where it mentions expose. I guess you could worm shirt up down sideways etc but then you never see complete picture, only pieces and could miss a key piece. I wonder how many here do heart, lung, and abd sounds thru the shirt instead on the skin? If your moving clothes around to do your exam it seems it may be more professional to just remove the clothing and do it like the doc, then maybe people would remember more than us being ambulance drivers.

[Chief1C]

Ok you made a statement that would require shirt cut away to be splinted actually can be done with shirt on, should it no.

It is my personal opinion, that this is the best way to treat each individual patient.

[spenac]

If you are transporting a 40 year old woman complaining of a headache are you gonna take all her clothes off?

If you are transporting a 14 year old female or male with nausea and vomiting do the clothes need to come off?

I vote no on the two above but someone will disagree with me I am sure but we have to use common sense here. There are many situations that require the clothes off but generic medical complaints are in my opininon not one of them. But there are times where the clothes should come off.

Are you going to take off the clothes of a patient whose only complaint is abdominal pain or a headache?

Hospital gowns are good if you have them but not every ambulance has access to them.

I do believe that if an IV Is needed then at least take off the shirt and if there is one, the bra but make sure you cover them back up.

Your two female patients probably OB's if in my part of world so strip.

"Common sense" get ready for a beating if any one catches that statement.

Hospital gowns no problem use sheet to cover or buy disposable gowns for ambulance.

[Just Plain Ruff]

I'm not worried about someone catching the common sense part of my argument. I stand by what I say.

It's all in the presentation of the patient. if the patient warrants being disrobed I will do that but if they don't then why open yourself to any type of liability or improper activities complaint.

I've always used what I consider common sense in determining who should be disrobed and who shouldn't.

It's a case by case basis, many patients do not need to be completely disrobed but many do.

[CBEMT]

here. The Brady paramedic book says to expose to examine chest area of patient for cardiac problems not codes but problems to properly assess, just one of many examples found in brady, mosby, aaos paramedic books where it mentions expose.

Oh good. A textbook EMT.

Your two female patients probably OB's if in my part of world so strip.

The chief complaint in a 40 year-old female is a headache, and you're thinking OB?

"Common sense" get ready for a beating if any one catches that statement.

What?

[spenac]

I'm not worried about someone catching the common sense part of my argument. I stand by what I say.

It's all in the presentation of the patient. if the patient warrants being disrobed I will do that but if they don't then why open yourself to any type of liability or improper activities complaint.

I've always used what I consider common sense in determining who should be disrobed and who shouldn't.

It's a case by case basis, many patients do not need to be completely disrobed but many do.

I agree fully about common sense but some of the comments I received when I said it makes you wonder if it's illegal to say it.

The way I understand is that disrobing a patient, or for that matter any other procedure, should be done basically same for any patient with similar complaint. For example if all the slim large breasted woman that you start IV's on have shirts and bras removed but you fail to do the same with fat small breasted woman it would be an easy case to prove wrongdoing. Consistency makes us better at what we do and makes it easier to defend our actions in a court of law if the need arises.

It really is a case by case decision that needs to be made. But a side thought is that maybe it would stop some taxi rides if all required to disrobe, a point to ponder.

[spenac]

Oh good. A textbook EMT.

The chief complaint in a 40 year-old female is a headache, and you're thinking OB?

What?

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

Headache = eclampsia

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

[Dustdevil]

I don't get this whole scenario, so let's talk this out.

EMTs splint a painful arm without disrobing the patient. Perfectly acceptable. Not a problem, medically speaking. I don't ever recall any EMT class I have witnessed require disrobing a victim for extremity splinting. It certainly isn't on the NREMT checklist. There is your standard of care, right there.

Then the hospital apparently x-rays and casts the victim -- meaning she WAS disrobed -- and fails to notice or recognise the other bruises and act on them. Not acceptable. This WAS covered in nursing school.

This is another case of what CBEMT mentioned in a previous topic. These guys weren't fired for doing anything wrong. They were fired because their patient brought bad press to the agency.

[spenac]

I don't get this whole scenario, so let's talk this out.

EMTs splint a painful arm without disrobing the patient. Perfectly acceptable. Not a problem, medically speaking. I don't ever recall any EMT class I have witnessed require disrobing a victim for extremity splinting. It certainly isn't on the NREMT checklist. There is your standard of care, right there.

Then the hospital apparently x-rays and casts the victim -- meaning she WAS disrobed -- and fails to notice or recognise the other bruises and act on them. Not acceptable. This WAS covered in nursing school.

This is another case of what CBEMT mentioned in a previous topic. These guys weren't fired for doing anything wrong. They were fired because their patient brought bad press to the agency.

Dust a broken humerus would not cause you any thought of additional potential injury that would at least cause you to look under the shirt? I mean the healthy humerus is tough and requires a lot of energy to break. Energy transfers. Should you at least look for other possible injurys related just to this event and by doing this uncover the older wounds? Your right don't have to remove clothes for extremity splinting but you should if any possibility of additional injury and in this case lots of reason to think more injury possible. If anything about an injury should have triggered additional exams lawyers will be all over it if not done and thats what they will call standard of care that other people at same level of education would have looked deeper than just the arm.

As far as abuse report child protective services should have received several notices of possible abuse but received none. Failure of EMS and hospital staff. EMS because reasonably the medics should have been inclined to exam a little closer due to the type of injury. Had it only been the wrist, easy to damage the wrist, could see just splinting without thinking of checking more than the arm.

[speedygodzilla]

2 medics being fired and facing legal issues for failing first to find the signs of child abuse and then by default failing to report it. Child died as result. They had listened to mothers explanation of arm injury and did not examine any other skin area, thus missed all the bruises of different ages on the child.

So whats your thoughts, should all patients have clothing removed and put in hospital gown or under sheet to avoid missing the less obvious? Do any services require something like this?

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.