new paramedic... another question for the nurses.

[paramedic_t]

hello, i've been at this paramedic thing for about 3 months now. I posted not too long ago about my partner getting angry with me about making an unconscious patient trauma naked.

anyway, we talked things through and she took back her harsh comments, and told me that i dont always have to go by the book... but it seems we've run into problems again for the same reason.

I had an 19 y.o male pt this week with multiple gsw's who flatlined in the ambulance. We began CPR on the patient who's clothes we had already been cut off. Upon arrival at the E.R we removed the patient and continued cpr while rolling him down the hall to the trauma room. Clearly, there was little time and little priority to cover up his member before moving him (nor did my partner instruct me to).

However, afterwards a nurse scolded me for not covering him before moving him and my partner did not even defend me in the situation. She told me that she was busy giving the pt air and that covering him was my job.

Is it really that big of an issue to move a patient in cardiac arrest without covering them? What makes me most angry is that the pt survived and i did not recieve any credit!

some feedback please?

[Blee O'Myacin, BSN, RN]

I wouldn't have scolded you. I would have grabbed a towel and covered the guy's parts myself. Sheesh.

I think that perhaps the nurses got flack from the supervisors who flock to codes like moths to a light and if they see anything that is not aesthetically pleasing to the eye, they're all over us about it.

Just to give you a bit of perpective. The ED nurse has 5 patients, you roll in the sixth, coding. The team jumps into action and the nurse cracks the code cart and starts pushing meds. Just then, the VP of nursing comes strolling through to see why patients are in the waiting room for the five minutes that the code was running and oops, there's the patient's member. Her twinset and perfectly coiffed hairdo wilts in the face of such horror and asks to speak to the staff nurse. The staff nurse wipes the sweat and blood and normal trauma code gore off her arms (and don't forget to take off those gloves in the hallway!!!) and goes out there to explain why no one perserved modesty (and there are three empty hall stretchers!). You, my paramedic friend, were thrown to the wolves. I think that stinks, considering that we are all part of the same team. (Upper managment included, but they don't see it that way unfortunately)

I agree with the other posters to start to work on that partnership with your co-medic. You two have to be able to trust and depend on each other "out there".

Stay safe,

Blee

[mama_d, BSN, RN]

I can't begin to tell you how many times we've coded a patient, had their "junk" and other assorted body parts hanging in the wind, and had people consistently leave the door to the room open and the curtain open.

I try to be extra careful about it b/c we had a woman rush up to the hospital after we called her in in the middle of the night to find us coding her husband with his door wide open; it took that one experience to make me extra vigilant about trying to be the one to pay attention to that kind of thing. I've even called out "curtain" or "door" when we were in the middle of coding people so that the "runner" was reminded to take care of it, if I'm not in a position to do so.

I wasn't there, but from what you've posted, yeah, you could've covered him up....but so could many other people along the way. Sometimes patient dignity takes a backseat to ABC's (just realized that D for dignity fits right on the back of that...maybe I should copyright "ABCD's" and market it to the people who write fundamentals books and make me some dough). Personally, if I'm ever being coded, I wouldn't care if people posted the video on YouTube if they managed to bring me back...I'd be thanking my lucky stars that I had competent people bring me back.

[MedicalLPN, LPN]

How would you feel if you were the one on the cart, showing all of your junk to the world?

This is me, but if I were on the cart, being dead would be my primary concern :)

To the OP, just remember to throw a sheet over the patient before you take them off the ambulance. You're new at this, your adrenaline was pumping, you were more concerned about the patient being in asystole than the fact they were exposed, and for that just let it go, and next time try to keep in mind to cover the patient when transfering.

In the hospital, as other poster's have stated, the patient is naked during a code, however if the patient is revived before we start hauling but to the ICU we throw a sheet over the patient, at the same time in a hospital during a code generally you have a lot more help than when you're in the back of an ambulance, and not for nothing but hey you're partner should have made sure a sheet was on the patient as well.

The nurse that scolded you should have just pulled you aside afterwards and said "Hey, next time remember to put a sheet or garment over the patient when you're transfering the patient." instead of scolding you.

Don't beat yourself up over this, you're not a bad person or medic because you were more concerned about reviving the patient than making sure he wasn't exposed like I said just try to be more aware of the dignity thing in the future and it'll become second nature.

[flightnurse2b, LPN]

i don't have much to add except to bump up the fact that your partner has thrown you under the bus more than once and thats something in EMS that you don't do. my partner and i were thick as theives when we worked together. she would have jumped in a river of boiling snot to help me, and i would have done the same for her. thats how lives get saved. you cannot successfully run rescue with a partner that is not going to have your back. i agree completely with the people who advised you to try and form a better relationship with this person. she may be one who just needs some constructive criticism---or for you to give her a gentle reminder that you are on the same team.

i admit i've wheeled a nude patient into the ED, honestly as a medic i can say that i dont really ever notice they're naked until after i've reported off to the staff. i get in my zone. all i see is asystole, vfib, hemorrhage, resp arrest, whatever and i work on it. i'm not warm and fuzzy at that point. because if it were me, i would want a competent paramedic to not use any time covering my boobies while they did CPR.

but as someone who worked in the ED, blee makes a very valid point. there are enough people working in the ER, esp when a rescue comes in, that they could have sent another nurse or a PCT for a towel to cover the man's stuff... you did what you were supposed to. save his life.

alot of times EMS gets the bad rap for patients coming in in less than perfect condition. it's difficult to explain, without sounding like a complete jerk, that i'm sorry i broke nannie's dentures while intubating her, but i was trying to save her life. i've more than once had an ER nurse bark at me for cutting off clothes, using makeshift dressings, etc. you do what you have to do in the field.

you sound like you are on your way to being an excellent paramedic. keep up the good work, and i hope that things between you and your partner work out.

[MedicalLPN, LPN]

alot of times EMS gets the bad rap for patients coming in in less than perfect condition. it's difficult to explain, without sounding like a complete jerk, that i'm sorry i broke nannie's dentures while intubating her, but i was trying to save her life. i've more than once had an ER nurse bark at me for cutting off clothes, using makeshift dressings, etc. you do what you have to do in the field.

This is very true. I've noticed that there seems to be a rivalry between some medics and nurses. A medic gets treated bad by a nurse or a nurse gets treated bad by a medic and boom suddenly all nurses or all medics are the seeds of satan. It's really quite silly, both professions have a different skill set and different mind set. I have learned a lot from the medics I know both professionally and personally, and likewise they have learned from me. Anyway I'm off topic, just felt compelled to hop on my soap box for a moment :)

[leslie :-D]

sorry to hear about your partner turning on you like that.

bottom line is that it's no one in particular's job, but any/everyone's.

and while we all acknowledge on an intellectual level, that the priority here is to save a life...

emotionally, people/pts will react to the thought of being exposed, and will, even momentarily, wish they were dead.

when a certain thought evokes such a strong reaction, you can bet that any interventions to prevent such an 'atrocity', is pretty high on the priority ladder.

unless one is a professional flasher, it's safe to say that most folks would consider it imperative to be covered at all times.

leslie

[Medic09, BSN, RN, EMT-P]

Blee, your description of the ER and VP of Nursing was brilliant! If I'd been drinking milk, it all would have come out my nose!

That made my night; thanks!