Trauma Naked? - page 11

I was in an MVA a month ago. Paramedics cut off my shirt, and strapped me on a backboard. When I got to the E.R, I was conscious, with no visible injuries, just a bit of a headache. Yet, I was almost immediately stripped... Read More

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    Quote from TiredMD
    You have to understand that the decision on how a trauma workup proceeds in made based on the individual circumstances of the trauma and the clinical presentation of the patient. It is not a "one-size-fits-all" process, but neither is it a negotiation with the patient. The decision on whether to cut off a patient's clothes, or insert a catheter, or intubate, is made by health care professionals who have the benefit of experience and education that the patient does not.

    I have physically fought gunshot victims who insisted they were fine up to the moment they lost their vitals. I have restrained head injured individuals who "knew" they were okay but had one blown pupil. I have forcibly cut off the clothes of "uninjured" patients only to find bullet holes and stab wounds.

    I get the fear of the general public when they hear about clothes being cut off, forced rectal exams, catheters, and the like. But I (and everyone else here who has done even a little trauma) know that we can essentially bring the dead back to life with an adequate assessment and timely treatment. And I would much rather appologize to a woman for cutting off her clothes, than appologize to her children for missing the wound that killed her.
    Bravo..last thing the trauma team needs to worry about is societal niceties. I work in a level one trauma hospital and many patients come in insisting they are fine.That they don't need that urine test. Many times this may be because they have been drugging and are afraid that they will get in trouble. In my facility, any trauma that comes in conscious or not, gets a tox screen.

    What has this society come to, where we have to apologize now for doing our jobs? I guess gone are the days where you saved someone's life, and they were appreciative, not looking to run crying off to an ambulance chaser lawyer. I know someone will say, "but I wasn't hurt that badly". Well, we can't be sure of that when you're brought in...we lost a patient once who had been having a full conversation with us before anesthesia put him to sleep. He had been shot, but was laughing, cracking jokes. He died on the table. Things were much worse once we opened him.

    Sorry, if you come into my OR as a trauma, keeping you alive is going to be my focus. Sorry if your favorite jeans may have to be cut off of you, but I guess at least you'll be alive to complain about it later..
    canoehead and Altra like this.

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  2. 0
    Quote from ;3211131
    if a patient involved in a trauma presented to the emergency room, relatively calm and coherent, and during the examination told you that he did not want part of the workup done, what then would be the likely reaction of the medical staff? you state that if the patient yells, fights, or appears combative he would be considered not competent due to his injuries, and treated against his will. i would like to ask just what may be the outcome if he were to calmly explain to staff that he wished to refuse the urinary catheter? patients in this situation are scared and frightened, and forcing unwanted, painful procedures upon them would seem to greatly increase patient's anxiety. i preface this by saying i do NOT want to sue anyone, especially someone abiding by my wishes.
    J.R.theR.N2b You are right. I would always be rational and polite to begin with but somethings tells me that if I calmly try to talk nobody will listen as I'm on a gurney being rushed all around the E.R. I also would not want to refuse treatment, I would only want to slow things down a little. I would want to calmly tell somebody what I believe to be wrong with me, knowing there is probably a lot of injuries I couldn't know of. I would try to find a doctor or nurse I could be comfortable with, in my case a male if at all possible. I would like to be informed of what he is doing to me and why, and I would like to be taken someplace somewhat private before being stripped. This is, of course, if I were conscious and able to talk. But I would expect to be treated similarly if I were unconscious. I'm afraid that what would really happen is I would be taken in, ignored by everyone I try to talk with, be stripped naked in front of many nurses, receptionists, security guards, other patients and their families and friends. I would be left totally naked strapped to a gurney and wheeled around the E.R. and placed uncovered with several other patients of both genders while the doctors and nurses were running around like chickens with their heads cut off.

    By the way, I would never sue someone for doing what I asked. I guess you would just have to trust me with that.
  3. 2
    Quote from claybob
    I'm afraid that what would really happen is I would be taken in, ignored by everyone I try to talk with, be stripped naked in front of many nurses, receptionists, security guards, other patients and their families and friends. I would be left totally naked strapped to a gurney and wheeled around the E.R. and placed uncovered with several other patients of both genders while the doctors and nurses were running around like chickens with their heads cut off.
    We don't run, but other than that . . .
    canoehead and GadgetRN71 like this.
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    To the OP and others,
    It amazes ME that more trauma patients don't come in with much less clothing on than they already do. Assessing for traumatic injuries/major bleeds involves exposure, the E in the ABCs. This is all part of the primary survey!! As a field medic I have a responsibility to expose you to find any and all sources of trauma or bleeding. You miss what you don't see, and I don't have X ray vision. Once any airway issues are addressed, bleeding controlled, bones splinted, et cetera then I can do my best to keep your modesty intact, but I can't do that until I know have thoroughly assessed an area to determine it's status. Yes, it's uncomfortable. But it's also a necessary evil for us to do exactly that. We want to be sure you don't have any life threatening, limb threatening injuries that we're not seeing under those jeans. We're doing it for you.

    Yeah, it always makes me laugh when I see ER and their trauma patients are always fully clothed .
    GadgetRN71 likes this.
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    I apologize for calling what you guys do abuse. I understand that you are only doing what you think is best for me, and probably nearly everything you do is exactly what should be done. I just hope that whoever may be helping me will have some common sense and not be in so much of a hurry that you won't listen to me. I hope you will explain to me what you need to do to me and why and possibly let me assist you in your examination.
    I just have a moral issue with my privates being seen and especially touched by females. I realize in matters of possible life and death situations that moral issue should be ignored, but I would hope that my examination could be in a controlled environment and your best efforts be made to try to accomodate my wishes, even if I have to wait longer.
    Thanks for what you people do. I really do consider you all heroes.
    rn/writer likes this.
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    My girlfriend had an MVA last month, was unconsious, and was taken to the hospital via helicopter. She had closed head trauma, but not another scratch on her. Upon arrival to the hospital all her clothes were cut off. When I was informed of her hospitalization I of course rushed to the hospital. When I got to the E.R. I asked for her, was told where she was, and proceded to her Trauma room. (Not a soul even asked who I was) I found it to be at the end of a publicly traveled hallway. When I got close enough to focus on what was in front of me I found the curtain to the room open, and a clear view of her bare naked lower body. Where do people get off abusing the trust we are forced to give health care "professionals". Why would a patient's panties be cut off if the only injury is the head. Simply appauling!!!!!! Who do we go to to get help with abuses such as this?
    canoehead and claybob like this.
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    Why would a patient's panties be cut off if the only injury is the head.
    Because until the clothing is removed, ED staff can't determine that the only injury is the one to the head. Besides needing to visualize the entire body from head to toe, snaps and zippers and bra hooks and such interfere with things like x-rays and MRIs. It's nice when a gown can be put on or a sheet can be used to cover the person, but when you have an unconscious patient, the priority is airway, breathing, circulation, etc. In a shocky patient, you might have only minutes to head off an irreversible downward spiral. Getting labs and scans and doing a detailed assessment outweigh all other considerations. This goes double when the patient is unable to communicate. This has to happen in just a couple of minutes.

    An MVA serious enough to cause a closed-head injury may have caused significant internal damage below the neck as well. This is especially true with an unconscious patient who can't tell ED staff where it hurts. Even conscious patients may be in shock or so jacked up on adrenalin that they don't experience normal sensation. I've been on EMT calls where I got cut or scratched and didn't even feel it until things began to settle down.

    Yes, ED staff ought to be as respectful as possible of personal modesty, and it's good to have a reminder from the patient's perspective now and then, but removing trauma patients' clothing is more about doing a thorough examination than trying to embarrass anyone.

    I hope your girlfriend had a quick recovery.
    donsterRN and Farmer Jane like this.
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    Well, you definitely are in the nursing profession. You have given me the same line others have without answering my questions, or understanding the true concern. First off, IF there is a need to have a patient completely naked, I have no choice but to go along with it. The BIG issue here is that not only was she stripped naked, but was left in a room with a glass front, curtain there but opened, and easily viewable by the public. Nobody could possibly convince me that this was anything but wrong. She had no choice but to put her trust in the people who were taking care of her, and they abused the trust placed in them by putting her on public display. My question was "who do I complain to?".
    canoehead and claybob like this.
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    Actually she did answer your questions--you just didn't like the answers.
    You had two questions:
    1) why cut off her panties when the only injury is to the head?
    2) to whom do you report this abuse?

    She answered your first question--you don't know that the only injury is the head until you look, and clothing can interfere with certain tests.
    She told you this was not abuse, and why.

    I can understand that you are concerned that her nudity was visible. I would recommend that you write a letter to the director of the emergency department expressing your concern. As for making a formal complaint, I think you should have some perspective: your primary concern should be that your girlfriend recovers. The BIG issue here is that she was giving proper medical care!
    GadgetRN71, rn/writer, and donsterRN like this.
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    So, I am getting the idea that you think this practice is perfectly OK. Why don't we just build a glass enclosure in the lobby and deliver babies in there. Would be the same thing. Privacy curtains were there, but were not used. A choice made by the trauma staff, and a very unprofessional one I must add.
    claybob likes this.

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