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 completely naked. I laid there fully nude for what seemed like an eternity while I was examined. Then the nurse put a cup over my member and told me to pee. I wasn't able to, so they put a catheter in me.
I asked them to cover me several times, but the trauma team refused, even when i was given an ultra sound i was not covered up.
This just doesn't seem normal to me. Is this standard procedure or did I just get stuck with a bad trauma team.
On the other hand, administration may come down on the nurses that saved the guy and worry more about "customer service" and Press Gainey scores that what was really going on in the real world.
Sadly, you are right. And an isolated reprimand based on a complaint will do nothing but generate grumbling and gossip among staff as soon as the manager leaves the nurses station.
That said, I believe the person in the OP has a very valid complaint. I am afraid that what has developed in many emergency departments (and health care settings in general) is a collective sense of cynicism, frustration and resentment among staff, from aids and techs to nurses on up to physicians. I see examples of wonderful care given by those around me every night I work. I also see acts of supreme indifference and disrespect on those same shifts. I worry that the latter is growing while the former is slowly losing its place as the expected norm in patient care.
In too many places, administration has become so far removed from the actual act of caring for the sick and the wounded among us that they are oblivious to the problem. Floor managers run the gamut between excellent and terrible. There are still some out there that promote a caring and effective team approach in their facilities/units every day, and we as staff really need to raise them up and support them and appreciate them.
I guess I'm taking the long way around to make the short point that the best among our leaders are those who don't operate in reactive mode only when a complaint is made, but that still doesn't mean the complaint shouldn't made at all.
Sorry for the soapbox. I've worked the past seven nights and muddled through a four hour micro class this morning.
I know for us, trauma pts often sit on the table naked for quite a while, depending on the seriousness of injuries, level of suspicion, and the team itself. After we cut EVERYTHING off, if we place a blanket on the patient, it is usually ripped off and thrown to the floor by some resident who could just have easily moved it aside. With nurses busy doing a thousand things, I can't keep running across the department to get new blankets from the warmer. So often, depending on who's on the team that night, you might not get a blanket until they're done doing what they're doing....catheter, ultrasound and all. Yes, we try to keep trauma patients covered, but some days charting, meds, or orders take priority.
I have a friend who was, in his words, "blown up in Iraq." When he talks about waking up in a military hospital, the thing he brings up more than his injuries is how he was naked and nobody would cover him, even when he asked.
Maybe this sort of thing bothers patients more than we realize.
You make a very good point multi. I wonder how often fear of the treatment can lead people to refrain from getting care when needed.
I mentioned in a prior post about my involvement in an aircraft accident. Once things had settled down and I was out of the wreckage, I knew I was a hurtin' puppy. The sort of injuries you worry most about; head, neck, and spine; I had them. Having just had a bad run in with an ER visit in my hometown, I was scared to think of what would become of me if I presented myself for treatment. I chose to decline all offers of help from rescuers and resolved to walk to the airline terminal from where I was to try to meet my family. That would be a big task for someone healthy. I was confused, dazed, in pain, and in a strange city. After walking away from the crash scene I ended up sitting beside the road until a police officer came along and convinced me to at least get checked out by EMS. It wasn't long before I was collared and strapped to a back board, and I was getting freaked out at my loss of control. At the hospital, I was fortunate to encounter a great trauma team. I explained my concerns about modesty, half expecting to be ridiculed. To my relief and astonishment, they seemed to understand. Curtains were closed and 2 guys laid a sheet over me and cut my clothing off from under the sheet. They were even careful not to cut my newly purchased trouser belt. I still have it today. They cleaned me up pretty good, and I was soaked in rainwater and jet fuel. I got the full trauma treatment. Every square inch of my body was checked but the treatment team worked around the sheets or blankets only uncovering what they had to for only as long as they needed to. I refused the catheter and gave them a urine sample in a cup. Nobody seemed to think less of me. Even with all the x-rays and untrasounds everyone was tops in preserving my dignity. I came out of the ER feeling real good about the treatment I received.
Was I treated well because the incident was a major media event and the hospital knew they might be under a microscope? Or was it just a darn good team of caring individuals? I like to think it was the latter. I wish now I had taken the time to go back and properly thank them.
As good as the ER staff was, the floor staff was the opposite. My stay ended early, and I left AMA and drove back home.
I think it is sometimes assumed that a sick or injured person isn't concerned about modesty. I know that's not the case from personal experience. Here I had health insurance coverage and I knew the airline would cover any other expenses. That was not my concern. My dignity was more important to me at the moment, and a prior bad experience had me on edge.
Sorry the OP had his experience, I think he suffered needlessly.
Our ER staff has actually talked about this . . . if we come in as a patient to the ER, please keep us covered up and pull the curtain when doing invasive things. Oh, and for me, cover up my feet. I just have a thing about my feet being uncovered. So, at least put some socks on my feet.
We do tend to depersonalize people - my class talked about this last week. We call them "The COPD'er in 305" or even "305".
Part of it is HIPAA . . . I realize that. However . . part of it is not.
steph
for those who readily agree that what happened to the original poster was necessary, i find it very difficult to disagree with you. however, the comment from "spidey'smom" that her and her co-workers, if they are brought into the ER, wish to be covered up and have the curtains pulled before anything invasive was done, keeps haunting me. another type of double standard???????? i once heard a very experienced surgeon define MAJOR surgery as "any operation, of any kind,-----done on me!!!!!!
thank you all for your answers. they helpped alot.
I was speaking to someone about my incident, he said the same thing happened to him once when he had an asthma attack.
what i wanted to ask is, why on earth someone would have to be naked to be treated for an asthma attack. He had never had any occurance of asthma before, could this be why?
Not a nurse yet, but I do know from having volunteered as an EMT for many years that if I 'called' a trauma, one of the things we did once we were enroute (after we got oxygen going and any other potentially lifesaving interventions), was cut off all the clothes. The person is strapped to a board and until spinal cord injuries are ruled out, you don't want to move them around just to get clothing off (which is why they get cut). People out in the field are constantly trained that "you can't treat what you can't see". Having said that, I've never seen anyone not put a sheet over a patient and keep it over most of the patient except when absolutely necessary to examine or treat a given area.
Medical emergencies are a little different when it comes to removing 'all' the clothing. They're more case by case basis. If there's any question as to whether serious injury could have occurred (say the asthmatic person fell down stairs during an attack) then they're also treated as a potential trauma.
CPR being performed? The top half definitely gets exposed. Hypothermia? All the clothes come off. Unconscious people - yep, all the clothes come off to try to figure out what's going on (e.g. pulsating abdominal mass?) Taxi ride to the hospital for 'swollen glands'? Okay...they can keep their clothes on (they'll be out of the ambulance faster when we drop 'em off at the triage waiting room).
I'm so sorry you felt vulnerable and exposed. I would like to think you were at least being treated by those whose intentions were to err on the side of caution for some reason particular to your situation, as well as your friend's.
what i wanted to ask is, why on earth someone would have to be naked to be treated for an asthma attack. He had never had any occurance of asthma before, could this be why?
Just a little curious, thanks.
i would think to assess for outbreak of urticaria/hives, r/t possible allergic reaction?
I'm a volunteer EMT and have not been on any really bad trauma call yet. My crew has immobilized MVA patients for head trauma or possible C-spine, but none of those patients were stripped.
Now we did do an abdominal and thoracic assessment. Sometimes it was through the clothes for tenderness, sometimes opened the shirt but we never took a bra off if we opened a woman's shirt. We looked for blood on the clothes, all body surfaces when we log-rolled. The patients were conscious and they were not complaining of dyspnea or internal pain, their vital signs were stable, and there was no mechanism of injury that suggested major trauma - no huge jagged edges, no protrusions into the passenger compartment, no one thrown from the car, no one hit hard by the steering wheel. One windshield starred from an unbelted patient - we did open his shirt as well as board him.
Point being, on the calls when the paramedics came they didn't strip the patients or yell at us for not stripping them, and when we got the patients to the ER, none of the doctors or nurses yelled at us for not stripping the patients, and they don't strip them right away.
Now if indications had been otherwise - altered LOC, significant MOI, bleeding, bad/unstable VS, significant pain, SOB - we would have been cutting off clothes. I'm not sure that taking off the underpants is necessary in prehospital care - it's thin, you'll see blood - watch out for sanitary pad, Depends however. You can assess tenderness and crepitation through underwear, shift it to look for bruising.
For a routine PRECAUTIONARY board and collar, I don't think trauma naked is at all necessary and in the towns around here, we don't do it.
I get sent to the ER frequently to draw blood on trauma victims and in every trauma I have been to there always seems to be an RN or PCA standing by as they cut the clothes off to cover the victim up pretty much immediately. Many times it's just a towel over the genital region until a complete exam has been performed,
I'm a volunteer EMT and have not been on any really bad trauma call yet. My crew has immobilized MVA patients for head trauma or possible C-spine, but none of those patients were stripped.
Now we did do an abdominal and thoracic assessment. Sometimes it was through the clothes for tenderness, sometimes opened the shirt but we never took a bra off if we opened a woman's shirt. We looked for blood on the clothes, all body surfaces when we log-rolled. The patients were conscious and they were not complaining of dyspnea or internal pain, their vital signs were stable, and there was no mechanism of injury that suggested major trauma - no huge jagged edges, no protrusions into the passenger compartment, no one thrown from the car, no one hit hard by the steering wheel. One windshield starred from an unbelted patient - we did open his shirt as well as board him.
Point being, on the calls when the paramedics came they didn't strip the patients or yell at us for not stripping them, and when we got the patients to the ER, none of the doctors or nurses yelled at us for not stripping the patients, and they don't strip them right away.
Now if indications had been otherwise - altered LOC, significant MOI, bleeding, bad/unstable VS, significant pain, SOB - we would have been cutting off clothes. I'm not sure that taking off the underpants is necessary in prehospital care - it's thin, you'll see blood - watch out for sanitary pad, Depends however. You can assess tenderness and crepitation through underwear, shift it to look for bruising.
For a routine PRECAUTIONARY board and collar, I don't think trauma naked is at all necessary and in the towns around here, we don't do it.
Just wanted to clarify...I too have never cut the clothes off of a routine 'neck and back'. I had based my answer on words used by the original poster - paramedics and trauma team. Where I live anyway, a paramedic would never be used to transport a routine 'neck and back', and neither would a trauma team have been set up. So...I don't know if the original poster used those terms with the intention of referring to EMS and ER staff IN GENERAL or if he really was speaking of paramedics and a trauma team.
I too would find it unusual for him to have been stripped for a routine 'neck and back'. But after calling a trauma...they always arrive with the clothes cut off ready for the team. It's possible his situation was one where the decision to 'call' it was made to be absolutely on the safe side. It's expected of good EMS personnel to do that when in doubt, rather than ever making the opposite mistake of not calling one that should have been called, and the patient delays getting into surgery because no trauma team had been set up.
So, at least put some socks on my feet.
southlandshari
66 Posts
Sadly, you are right. And an isolated reprimand based on a complaint will do nothing but generate grumbling and gossip among staff as soon as the manager leaves the nurses station.
That said, I believe the person in the OP has a very valid complaint. I am afraid that what has developed in many emergency departments (and health care settings in general) is a collective sense of cynicism, frustration and resentment among staff, from aids and techs to nurses on up to physicians. I see examples of wonderful care given by those around me every night I work. I also see acts of supreme indifference and disrespect on those same shifts. I worry that the latter is growing while the former is slowly losing its place as the expected norm in patient care.
In too many places, administration has become so far removed from the actual act of caring for the sick and the wounded among us that they are oblivious to the problem. Floor managers run the gamut between excellent and terrible. There are still some out there that promote a caring and effective team approach in their facilities/units every day, and we as staff really need to raise them up and support them and appreciate them.
I guess I'm taking the long way around to make the short point that the best among our leaders are those who don't operate in reactive mode only when a complaint is made, but that still doesn't mean the complaint shouldn't made at all.
Sorry for the soapbox. I've worked the past seven nights and muddled through a four hour micro class this morning.