Trauma Naked?

[mark90]

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.

Please help me figure this one out.

Thanks,

Mark.

[woody62, RN]

Over the years, I have been in the ER more times then I care to remember, for more things then I thought possible. I have been there dor hypoglycemia, asthma, burn on my foot, multiple trauma-1989, life threatening medical emergency, broke ankle, broken arm. I had my pants cut off me in the field before being transported, I was stripped of my clothes, in the ER, during the medical emergency. I was never stripped of my clothes during any other visit to the ER but I was put into a patient gown. To be honest, when I arrived following my car accident, I was more concerned with my fractures, my closed head injury and being evaluated, then I was about being nake.

I also watch a great deal of Trauma Life in the ER. I have noticed they strip the patient and leave them stripped, except when transporting them outof the ER for other testing. I understand the reason for this being done and have rarely heard a patient complain. But they do explain why they are leaving them nake.

Woody:twocents:

[birdgardner]

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.

Ah - there's the distinction, between "calling it in" which we always do five minutes out, and calling for the trauma team to be set up. As I said, I've had no experience with major trauma. We have had the paramedics on scene but they've released to BLS.

Thanks.

[Altra, BSN, RN]

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?

From what you've posted here, your friend presented to the ER with acute onset of shortness of breath. The diagnosis of asthma came later.

In lay terms, it can be a very short trip from "having trouble breathing" to "not breathing". When my patient is acutely SOB, absolutely I need their shirt and upper undergarments off immediately - I need access to their chest to auscultate lung sounds anteriorly and posteriorly, place cardiac monitor & EKG leads, and get a look at their chest and abdomen.

If it is the case that the rest of your friend's clothes were also removed (the bottom half), it might be that the first 2-3 minutes of interventions (O2, initiation of neb tx, etc.) did not improve his/her respiratory status sufficiently that the staff could rule out the possibility of things progressing to respiratory arrest with the need for intubation.

BTW, I've never had an acutely SOB patient complain about having their upper half exposed -- the sensation of SOB tends to produce the instinctive choice to get everything anywhere near the neck off.

[mshultz]

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.

Please help me figure this one out.

Thanks,

Mark.

My experience in healthcare is limited. I took an EMT-A course many years ago, but never got involved after I passed the course. We were told that trauma equals naked. I did not expect to actually see any naked people when I did my time at the hospital, and was surprised to see naked patients of both sexes.

So, when I needed to call the squad on myself in 2003 for a bad GI bleed, I figured that their experiences were the same as mine. Since I was unable to clean the dried blood and fecal matter off of myself, I chose to lie naked on the floor while waiting for them. The squad covered me with a blanket just before they took me outside to the ambulance.

The first thing the trauma squad at the hospital did was to uncover me, after which they introduced themselves. I was not covered up again until they were ready to transfer me to the ICU. The ICU nurse uncovered me so that I could slide across to the bed, and then she covered me back up, and introduced herself (They have an interesting way of introducing themselves in the hospital

My oral temperature in the ED was about 93 F. Despite being naked during the treatment and registration process, I was not cold. However, I did shiver violently during the short period of time when I was naked while moving onto the ICU bed.

I quickly got used to being naked, and actually found it to be an interesting new experience. I would much rather be naked than sedated. The creepy amnesia during the last part of my outpatient colonoscopy was a profoundly unpleasant experience (I had attempted to watch, but ended up requesting more drugs. I greatly regret making that request, now).

I guess we all have different things that bother us.

[parker_trauma]

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?

Just a little curious, thanks.

The fact that he never had any previous occurence of asthma is probably the reason why he had to be in the nude. The medical personal may have decided to do a complete body inspection to check for anything that maybe causing the patient to be SOB. If he was catheterized that's they needed urine to discover what was causing his illness.

As for your situation, I can see why you feel you were mistreated. However, the trauma team was not at fault. Where I work, any MVA victim that is rolled in on a spineboard, is made naked, and urine is necessary so if you can't give it yourself a catheter is needed. Usually I would cover a patient after i catheterize them, but sometimes the situation is so critical that modesty is not a high priority. But in your defense, your situation did not seem to be that critical. Nudity is just a part of trauma, sorry that you had to experience it, but I am glad that your fine.

Parker

[MassED, BSN, RN]

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.

Please help me figure this one out.

Thanks,

Mark.

some shred of privacy is always provided - at least to the genitalia, if nothing else - until exam is completed. Unless it was a full on trauma, in which case you could be stark naked and no one would think about that....No, not the norm, if your case is as what you write.

[MassED, BSN, RN]

To be the devil's advocate here, it doesn't sound like they "saved" the guy. It sounds like they did a trauma assessment because there was significant damage to the motor vehicle, but that the patient was NOT significantly hurt and has no grounds for being particularly grateful. Maybe the OP wouldn't mind giving us an idea of the severity of his injury?

Now let's talk emotional trauma - the patient is shaken up from the accident, strapped to a board and immobilized, stripped naked, catheter stuck up his urethra without a by your leave, maybe gets a rectal exam, no one covers him when he asks, he's powerless - the aftereffects of that could be lasting and a whole lot worse for him than the physical effects of the accident.

You trauma nurses have seen it all and done it all and it means nothing to you any more, but it means a LOT to the patient. He should have had at least a towel over his loins right away, and no one should be telling him "just get over it."

I've been a EMT for a relatively short time and in nursing I'm still a student and you can tell me I don't know the real world yet - but anyone who says that is losing sight of what is real for the patients.

covered up at some point, usually sooner than later when at all possible - that's what most here are writing - but the patient's injuries, or discovery of them, is of utmost importance.

[MassED, BSN, RN]

I don't mean that trauma nurses don't care, but that they don't have an emotional response to nudity any more, so they have to remind themselves that it matters to the patient.

It can be very easy to think, "It's not a big deal to me, so why does it matter so much to you?"

that is not true. I always consider how a patient feels based on how I would feel in that scenario - always privacy and autonomy when able.

[MassED, BSN, RN]

In trauma training we learn that the pt needs to be covered with a warm blanket ASAP to prevent hypothermia in the event of shock etc. Unfortunately a lot of us seem to forget this too often.

As far as the point made earlier that a cover could hide injuries, I don't agree. This is what 1:1 nursing care is for and why vital signs are checked extremely often.

There is no need to keep a pt naked after the initial exam.

we don't know from OP scenario that he was hypothermic or at risk thereof - if there was a risk for hypothermia, they would have placed warm blankets or a BEAR hugger on him.... so that doesn't appear to be part of the equation - I'm assuming his VS were stable... as far as I can tell, the issue is privacy after stabilization.

[MassED, BSN, RN]

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

no, it's not HIPPA - it's called, "can't remember that frickin' name" - it's the "COPD'er in room 12, or the UGI bleed in room 2, or the PIA in in the hall in front of my face!" We all remember scenarios and situations better than personalizing those with names - it's too hard with the turnaround anyway.

[MassED, BSN, RN]

medic motto:

"make 'em naked"

dont know if anyone else said that, but wanted to mention. thats what we are taught, military taught here, and in my area where i do volunteer medic, same thing.

sorry to hear what you went thru, but spread the word- refuse!! you can always refuse!!

-H-

not if there's a suspicion of a head injury....

[MassED, BSN, RN]

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.

also in that same vein, somewhat, I work with this nurse - has been a nurse for a LONG time... recently came to the ER from psych, I think. She has been in the ER for about a year or so..

I hear her reprimand patients, yell at them, talk down to them... refuse to get them what they want in a way that is most unprofessional (I WILL not do that right now). I was in a patient's room, her patient, starting an IV for her - and she comes in all chit chatty with the patient - but says "that is some SH-T" or something to that effect. She was referring to her veins, of which she couldn't find, but I did.

She thinks she's funny half of the time - which she's not. I'm surprised patients don't complain about her - or maybe they do and I just haven't heard.

I end up doing those things for the patients that ask because I feel like she's such a foul monster that they're afraid to approach her again. She's a total scatter brain and with three non-emergent patients, she's loses it. She REQUESTS that I'm near her to the charge nurse, which irritates me because I'm usually assigned before I get there (and she's already there). She likes for me to help her out or pick my brain, or hear her vent. I have my own crap to deal with! I don't like feeling bad for her patients, but who else will???? I'm not there full-time, but I can only imagine what the other nurses or docs must say. She can NOT cope in this environment. She was next to me in ACLS on our final test and did a "pssst" next to me, looking for answers! COME ON!!! I had my back turned to her and ignored her.

The sad thing is, there are a few like her... not many, but a few. This nurse freaks out at the thought of giving meds IV push - she'll ask about Zofran, or Benadryl... or an antibiotic that is common. She'll say, "how long does it take to push, what do you hand this one at?" Rather than look on her own.... TOTALLY OFF TOPIC, SORRY!!!!!

So I guess my point is even those that make complaints (because I'm SURE this nurse has had her fair share) doesn't change anything - she's still there...