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

[paramedic_t]

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?

[BrnEyedGirl, BSN, MSN, RN, APRN]

I think the only trauma pt I've ever received that was naked, was because he/she was naked when the trauma occurred. Maybe rather than ask "should I leave the under ware on next time?" you should be asking yourself "will I gain any important info about this pt by removing his/her under ware?". I think most of the EMT/paramedics I work with would tell you that MOST of the time, taking the time to remove under ware is wasting time that could be spent on transport/starting lines/SMR/giving meds etc. Don't let it ruin your day. It was a learning experience. One thing you might want to always remember,..just because we CAN, doesn't always mean we SHOULD.

[KyPinkRN]

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.

As an EMT myself I think you are absolutely right in exposing this man... we are taught in the first weeks of class to rule out all occult injuries... even if it means looking where we don't want to look. Don't let this one nit picky medic steer you away from doing a proper assessment of every patient. Look at it this way, its better to expose the man and rule out an injury than it is to miss something important because you were protecting their modesty. If he was that drunk he probably won't even remember anyway! You did the right thing!

[Vito Andolini]

Thats what i said. She said that he didn't need to have his privates exposed to all those people. But the only people who saw were the police officers, and a few of his friends that the police were questioning.

Should I consider keeping the underwear on in that case from now on?

Or is this proper procedure I should continue to do?

You changed your story. First you said his friends were moved away, now yiou say they could see.

I think JBudd's advice is the best. do only what will help. don't do extra stuff in the field. Kind of swoop and scoot. Of course, you must follow procedure and policy or you risk being in trouble for not. Next time, ask [police to move the people completely away, expose minimally if at all.

Your partner should have covered him up if she thought you were doing something wrong.

[Vito Andolini]

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.

Nice to know - well, ok, but necessary to know?

[gonzo1, ASN, RN]

My only concern is that taking time to do such an in depth examination wastes rapid transport time.

airway

breathing

circulation

Consider less examination in the future in favor of rapid transport to the ER. I have never had a patient come in where the medics felt they had to see total patient naked before, except for the guy who accidently shot himself in the member and it was bleeding a lot.

It is good that you are trying to follow all the rules, but real life action is different than reading in the books.

Keep up the good work. I have a list a mile long of mistakes I have made, and some of them not so long ago.

[MN BigJ]

You did nothing wrong. If they guy had landed on something that stabbed into his back side or if he would have broke his pelvis somehow and rupptured his bladder with blood coming out of his meatus then nobody would be on your case. Don't worry about it. To put it bluntly, missing or catching something big is more important than if his friends saw is junk.

[nursejennie76]

Well I as the recieving ER nurse would be glad you cut them off-- because I am gonig to anyway, because he had bought himself a foley catheter and that would save me a step!! I used to work EMS and had to cut underwear off before, tell her to get her panties out of a knot!!

[ToxicShock]

Was the pt upset that you cut off his undies? If not, I wouldn't stress over it.

If anyone was "classless and immature" it would be your coworker for wording it like that! There are more constructive ways of getting your point across.

[Spritenurse1210, BSN, RN]

Id ignore her and go about your business. It sounds to me like she is just blowing off steam. You were trying to care for this person in a life threatening situation. Next time just cut off enough of the underwear necessary to assess your patient and then cover them asap