I am a new paramedic... In some hot water, need some help? In trouble?

Nurses General Nursing

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I had a patient, this week who had fallen of a balcony while drunk. He had a visible head injury and complained of tingling in his hands and feet and back pain. He was in and out of consciousness. I immobilized him and cut off all of his clothing down to his underwear. Once police got all of his friends away from the scene I removed his underwear as well so that i could examine his entire body. I left him naked for only 2 minutes max. then put covers on him. Once we left him in the E.R, my partner who is a 10th year paramedic yelled at me for taking off his underwear, she said it was "classless and immature" because he was conscious. She even threatened to report me. But that was what i was taught to do, and she said nothing on scene, plus as soon as he hit the e.r he was naked again anyway. Is she picking on me? or was i actually at fault? what would you have done?

i think you did the right thing my hubbie is a 8 year paramedic and he said that if you suspected a pelvic injury then you did the right thing although was it possible to do a pelvic squeeze?

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Specializes in ER/ICU/Flight.
Thanks for the input, really appreciated. Just a final question, if it were amore traumatic injury involving bleeding or cardiac arrest I would have to make the patient "trauma naked" no matter who was watching or where we were correct?

hey, sorry about your partner...everyone's worked with someone like that at some point in time. she probably waited until you got to the ER because she didn't want the nurses to think she had anything to do with the exposing of the patient.

the only times i've ever had to remove a patient's underwear in a pre-hospital setting have been in full-term labor and we needed to see if the baby was crowning and in a gsw victim when we were looking for exit wounds. if there aren't obvious injuries down there, then you can defer the exam to the physician (and that's exactly how i'd document it). if you ever do feel the need to expose someone's genitalia, then immediately cover it with a blanket, sheet, etc. there's never a reason to leave someone exposed like that for more than a few seconds unless you're placing a foley.

and if you're concerned about an sci, which it sounds like you were and rightfully so, you can check for priapism without removing their underwear. just touch their groin with the outside of your forearm and you'll know right away. maybe you'd heard that in emt-p school?

good luck and stay safe out there!

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The pt. fell approx. 12 feet. I examined his pelvic girldle for injuries/ breaks and visually inspected his genitals for signs of injury. I also examined his lower abdomen for signs of internal injury. I felt I needed to have him completely exposed for that.

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Specializes in Nephrology, Cardiology, ER, ICU.

Hi there - I'm a pre-hospital RN with 9 years pre-hospital exp, 10 years as an RN in a level one trauma center and sorry - I wouldn't have cut his undies. I might have peaked under them, but wouldn't have cut them. However, yes, I would strip everything else off. And....if the undies were bloody, then yes, I would have cut them.

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Your co-worker shouldn't have gone off on you under these circumstances. That was unprofessional on their part. You are an EMT and did have good reason to suspect an injury to the pelvic/groin which did need to be checked.

In the future however when in the field I would handle it differently. Cover the area with a towel or blanket and then pull the undies down under it to assess for injury when in the field. This will allow you to do your job and afford the patient the most privacy as possible. Although I believe your intentions were pure and you didn't do anything that needs reporting you can change your behavior if the same circumstances present themselves again. There is no need to leave them completely nude for 2 minutes especially when they can be viewed by others but consider this a learning experience and move on. Just the fact that you are asking and willing to learn leads me to believe you want to be the best you can be.

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When I worked as a medic I would remove underwear when I thought it was appropriate but after a quick look/exam (10-20 seconds) would toss the cut up shirt over the genital area. I would do the same with women and cover up their breasts after checking their chest.

But don't sweat it--you are a new medic and if that is the worst you do be happy! Medics can eat their young too!

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i feel really stupid asking all of these amateur questions, but i figure none of you know me and were already in conversation so I might as well ask.

In training, I was made to believe that a nude patient was very normal and something I would see often. I was told that anytime I wasn't sure about an injury "make the patient naked". I even explained that to my partner. And I guess I did leave the patient nude for a bit too long. But that was because we had a female mva pt. 2 days earlier who had her underwear cut off by my partner and she was left exposed for at least a few minutes while she was examined (difference was she had a visible pelvic injury). So i guess this was a good learning experience for me.

I was just wondering, I know to wait until bystanders are gone to expose a patient, but police and fire are allowed to be there correct? I was a bit confused on this when my partner told me not to expose the patient in front of them. And I'm a bit scared to clear things up with her. So if you can help me that would be great.

p.s Ive only been at this 2 weeks, thats why i sound so stupid.

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Specializes in Emergency Dept.

It doesn't sound like it was absolutely necessary to cut the undies - but certainly nothing reportable as you were threatened with. You said you were new, so it sounds like it would've been a good learning opportunity and at worst she should've pulled you aside later and explained why she probably would've done that a little differently.

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Specializes in Flight, ER, Transport, ICU/Critical Care.

I'm gonna try and make some sense out of the senseless (You have been warned! :confused:)

• You fully examined and exposed your patient. OK

• You noted that you had LEO and bystanders (the oh-my God squad)

• Admitted a TWO minute (exposure). :eek:

• Your paramedic partner (I presume) was all hacked off and let the world know once she got an audience in the ED

Now, I try - very hard - NOT to make absolute judgments - AS I WAS NOT THERE. And, since no two folks see things the same way - and hindsight always gets it right - even when I am really wrong - well, it makes it tough to make calls on the woulda, coulda and shoulda. But, even all of that noted -

Although I think (God, I hope) that you had the best interests of your patients well being in mind - I could see that TWO MINUTES of being FULLY EXPOSED might just have been a bit extreme.

I do try and expose all that is necessary. And yep I've had difficult situations, heck -I've had to defib in a post office on a woman (hands on defib -too) so she was exposed and all - but, I kept a sheet nearby and covered her ASAP. The point is necessity.

I might have exposed all but I'd have covered with a sheet and "peeked" as needed.

Actually, I've gotten to the point that I try and not expose (kidding!!) I've been traumatized (not really kidding!!) - by some of the "stuff" I've had to see. :sstrs:

I even had a recent "trauma" with LOC and of course she just had to be a crack ho and just out for sightseeing at 0400 when she hit a part of mother earth that did not yield to her car - and of course she was messed up and that pesky femur was broken to pieces (a piece fell on my boot when I was able to reduce/split the fx). Add to all this her crapped out crack ho veins and after assessment and exposure (left her bra on - I could palp chest as intact, good excursion and breath sounds) - I placed a well deserved IO in the head of her unbroken humerus. Well, nice tale and all that - but - the point (you knew I'd get there) I did not scissor off the bra (just another bad vision I did not need and would not change my care) - well, of course the trauma center had to "fully expose" and guess what - 2 little packs of "white powdered substance" fell out of her bra. Hmmm- my "failure to expose and desire to avoid" having to see yet another set of hoo-haas (that would not change my care/treatment) kept me from having to get too cozy po-po and keep up with crack (I mean errr...white powder in baggies) for all that legal crap. I was the LUCKY GIRL - that night. Still had to scrub bone pieces off my boots. :sfxpld: Warning: I learned most of my "lessons" the hard way. I suspect that the OP will have some "practice realignment" (will have learned a few lessons) after 17 years in the field. :p

It doesn't really matter that I think you messed up a little.

I think you could have fully assessed without that degree of "exposure".

I think you already know where you erred and why.

I'll hope that it is a lesson learned and leave it at that.

Now, I can cut off clothes (keep patient under a sheet) and initial assess in about 30 seconds. The key was the time the patient was left exposed. There are other options. Use them in the future.

Heck, if that turns out to be the worst thing you do in your career - you'll have had a wicked awesome practice. At the end of the day - just do your best. Don't make the same mistake twice and IF you lose - DON'T lose the lesson.

Practice SAFE!

;)

Oh yeah, I'm betting that your "ten year" experience partner pulled her share of dumba$$ stuff - if she doesn't admit to any either she is an idiot or a liar (both bad - just in real different ways!)

WANT TO BE CLEAR - all spinal restricted patients that need clothes removed are subject to having those cut - immobilization except for letting one slip off the pants is IMHO risky or just stupid - (Well, your honor I know the patient is in a w/c now after that accident - but, those were his favorite blue jeans that I didn't cut off ???)

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Specializes in Community Health, Med-Surg, Home Health.

I don't think you were wrong, you are new. Next time, cover with a towel or item of clothing before exposing the goodies, even for a few secs. Your partner over reacted...period.

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I guess I'd rather you cut my underwear off and see that nothing is wrong, than leave them on and miss something.

I'm sorry this happened. Sounds to me like it was blown out of proportion.

Maybe you need to speak with your supervisor and come up with a better clarification as to what the guidelines are for your specific situation.

Good luck to you!

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I'm no paramedic, but that was probably a good idea. You never know. He could've broken his tail bone, there could've been intense bruising or other signs that would've been nice to know when you finally did move him. It's nice to check on scene. If there had been something you would've missed by not checking, things could've been WORSE.

If he's drunk, so what? Drunk people expose themselves all the time... haha just kidding, but really it shouldn't be that big of a deal. She should grow up. Being naked in front of cops isn't the worst thing that could've happened... She's just jealous she wouldn't have thought of that :) But don't go ripping everyone's underwear off :)

But good luck, I hope you get that sorted out.

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