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.

[J.R.theR.N2b]

this is a very interesting topic. for most people it must appear rather stupid for a trauma victim to be refusing emergency room procedures. by putting myself in such a hypothetical situation, i can state how i would feel. first i would be very scared and likely in pain. rushed to the hospital, having your clothes cut off, leaving you naked in front of total strangers, and then having a catheter inserted is terribly unsettling. the last thing on our minds is to be cooperative. we are scared and we hurt, and all we want is for the pain to stop. however, before this occurs, he is subjected to more pain in the form of nasogastric tube and foley catheter insertions. this is not an attempt to rationalize patient refusals, and certainly not insinuating that hospital staff are sadistic and uncaring. a poster earlier advised someone that if he did not wish to be fully accessed for injuries, that he not seek medical care. this is very often not a possibility. many times ems will respond, not give the victim a choice, taking him to the hospital by force if necessary. the reality of it is the fact that all posters here make very compelling points, making it impossible to disagree with anyone. i guess what i am really asking is if anymore might be done to alleviate the pain the patient is subjected to.

[billsr1]

I was in a MVA once, my girlfriend (wife now) was driving and we made it two miles down the road and the next thing I know, I was flipping. The car flipped three times before stopping right next to a tree. I immediately checked on my girlfriend and pulled her out of the car. When the ambulance arrived, I was walking around talking to family telling them that we were fine. Needless to say, we did get a ride to the hospital on a board. Our clothes were never removed, we told them up front that we were fine and just had some X-rays done. We came out of the accident with two stitches, we were very lucky. When I went to get the CD player from that car, the owner of the junk yard asked me how I was able to get out of the car because he had to cut both doors off to get inside, if you say this car you would've thought I was in a major accident.

I realize that you have to follow certain protocol for traumas but that shouldn't take the place of a little common sense. If you have a patient that can tell you their name/SSN/Birthdate and who the President (questions that I was asked) is, I think it's pretty safe to assume that if they say they don't need that, you can take their word for it. They ARE going to know if something serious is wrong. You can't treat every patient the same because you really could do more harm than good. I had to practically be forced into the ambulance at the time, if someone would've tried to cut my clothes off and followed that procedure described in this topic, there would've been heck to pay. I'm sure most won't agree with me on this subject but every patient should have a say in his/her care before anything is done (if conscious of course). Jimmy

[TiredMD]

You can't treat every patient the same because you really could do more harm than good.

You have to understand that the decision on how a trauma workup proceeds in made based on the individual circumstances of the trauma and the clinical presentation of the patient. It is not a "one-size-fits-all" process, but neither is it a negotiation with the patient. The decision on whether to cut off a patient's clothes, or insert a catheter, or intubate, is made by health care professionals who have the benefit of experience and education that the patient does not.

I have physically fought gunshot victims who insisted they were fine up to the moment they lost their vitals. I have restrained head injured individuals who "knew" they were okay but had one blown pupil. I have forcibly cut off the clothes of "uninjured" patients only to find bullet holes and stab wounds.

I get the fear of the general public when they hear about clothes being cut off, forced rectal exams, catheters, and the like. But I (and everyone else here who has done even a little trauma) know that we can essentially bring the dead back to life with an adequate assessment and timely treatment. And I would much rather appologize to a woman for cutting off her clothes, than appologize to her children for missing the wound that killed her.

[bamagt]

Weird thing is I was in a bad car wreck 2 years ago and I was stripped completely naked like this too. I don't remember anything but I'll be working with all of these same people soon, doing my preceptorship.

haha

[GadgetRN71, ASN, RN]

You have to understand that the decision on how a trauma workup proceeds in made based on the individual circumstances of the trauma and the clinical presentation of the patient. It is not a "one-size-fits-all" process, but neither is it a negotiation with the patient. The decision on whether to cut off a patient's clothes, or insert a catheter, or intubate, is made by health care professionals who have the benefit of experience and education that the patient does not.

I have physically fought gunshot victims who insisted they were fine up to the moment they lost their vitals. I have restrained head injured individuals who "knew" they were okay but had one blown pupil. I have forcibly cut off the clothes of "uninjured" patients only to find bullet holes and stab wounds.

I get the fear of the general public when they hear about clothes being cut off, forced rectal exams, catheters, and the like. But I (and everyone else here who has done even a little trauma) know that we can essentially bring the dead back to life with an adequate assessment and timely treatment. And I would much rather appologize to a woman for cutting off her clothes, than appologize to her children for missing the wound that killed her.

:yeah:Bravo..last thing the trauma team needs to worry about is societal niceties. I work in a level one trauma hospital and many patients come in insisting they are fine.That they don't need that urine test. Many times this may be because they have been drugging and are afraid that they will get in trouble. In my facility, any trauma that comes in conscious or not, gets a tox screen.

What has this society come to, where we have to apologize now for doing our jobs? I guess gone are the days where you saved someone's life, and they were appreciative, not looking to run crying off to an ambulance chaser lawyer. I know someone will say, "but I wasn't hurt that badly". Well, we can't be sure of that when you're brought in...we lost a patient once who had been having a full conversation with us before anesthesia put him to sleep. He had been shot, but was laughing, cracking jokes. He died on the table. Things were much worse once we opened him.

Sorry, if you come into my OR as a trauma, keeping you alive is going to be my focus. Sorry if your favorite jeans may have to be cut off of you, but I guess at least you'll be alive to complain about it later..

[claybob]

if a patient involved in a trauma presented to the emergency room relatively calm and coherent, and during the examination told you that he did not want part of the workup done, what then would be the likely reaction of the medical staff? you state that if the patient yells, fights, or appears combative he would be considered not competent due to his injuries, and treated against his will. i would like to ask just what may be the outcome if he were to calmly explain to staff that he wished to refuse the urinary catheter? patients in this situation are scared and frightened, and forcing unwanted, painful procedures upon them would seem to greatly increase patient's anxiety. i preface this by saying i do NOT want to sue anyone, especially someone abiding by my wishes.[/quote']

J.R.theR.N2b You are right. I would always be rational and polite to begin with but somethings tells me that if I calmly try to talk nobody will listen as I'm on a gurney being rushed all around the E.R. I also would not want to refuse treatment, I would only want to slow things down a little. I would want to calmly tell somebody what I believe to be wrong with me, knowing there is probably a lot of injuries I couldn't know of. I would try to find a doctor or nurse I could be comfortable with, in my case a male if at all possible. I would like to be informed of what he is doing to me and why, and I would like to be taken someplace somewhat private before being stripped. This is, of course, if I were conscious and able to talk. But I would expect to be treated similarly if I were unconscious. I'm afraid that what would really happen is I would be taken in, ignored by everyone I try to talk with, be stripped naked in front of many nurses, receptionists, security guards, other patients and their families and friends. I would be left totally naked strapped to a gurney and wheeled around the E.R. and placed uncovered with several other patients of both genders while the doctors and nurses were running around like chickens with their heads cut off.

By the way, I would never sue someone for doing what I asked. I guess you would just have to trust me with that.

[TiredMD]

I'm afraid that what would really happen is I would be taken in, ignored by everyone I try to talk with, be stripped naked in front of many nurses, receptionists, security guards, other patients and their families and friends. I would be left totally naked strapped to a gurney and wheeled around the E.R. and placed uncovered with several other patients of both genders while the doctors and nurses were running around like chickens with their heads cut off.

We don't run, but other than that . . .

[vamedic4, EMT-P]

To the OP and others,

It amazes ME that more trauma patients don't come in with much less clothing on than they already do. Assessing for traumatic injuries/major bleeds involves exposure, the E in the ABCs. This is all part of the primary survey!! As a field medic I have a responsibility to expose you to find any and all sources of trauma or bleeding. You miss what you don't see, and I don't have X ray vision. Once any airway issues are addressed, bleeding controlled, bones splinted, et cetera then I can do my best to keep your modesty intact, but I can't do that until I know have thoroughly assessed an area to determine it's status. Yes, it's uncomfortable. But it's also a necessary evil for us to do exactly that. We want to be sure you don't have any life threatening, limb threatening injuries that we're not seeing under those jeans. We're doing it for you.

Yeah, it always makes me laugh when I see ER and their trauma patients are always fully clothed .

[claybob]

I apologize for calling what you guys do abuse. I understand that you are only doing what you think is best for me, and probably nearly everything you do is exactly what should be done. I just hope that whoever may be helping me will have some common sense and not be in so much of a hurry that you won't listen to me. I hope you will explain to me what you need to do to me and why and possibly let me assist you in your examination.

I just have a moral issue with my privates being seen and especially touched by females. I realize in matters of possible life and death situations that moral issue should be ignored, but I would hope that my examination could be in a controlled environment and your best efforts be made to try to accomodate my wishes, even if I have to wait longer.

Thanks for what you people do. I really do consider you all heroes.

[madashell]

My girlfriend had an MVA last month, was unconsious, and was taken to the hospital via helicopter. She had closed head trauma, but not another scratch on her. Upon arrival to the hospital all her clothes were cut off. When I was informed of her hospitalization I of course rushed to the hospital. When I got to the E.R. I asked for her, was told where she was, and proceded to her Trauma room. (Not a soul even asked who I was) I found it to be at the end of a publicly traveled hallway. When I got close enough to focus on what was in front of me I found the curtain to the room open, and a clear view of her bare naked lower body. Where do people get off abusing the trust we are forced to give health care "professionals". Why would a patient's panties be cut off if the only injury is the head. Simply appauling!!!!!! Who do we go to to get help with abuses such as this?

[rn/writer, RN]

Why would a patient's panties be cut off if the only injury is the head.

Because until the clothing is removed, ED staff can't determine that the only injury is the one to the head. Besides needing to visualize the entire body from head to toe, snaps and zippers and bra hooks and such interfere with things like x-rays and MRIs. It's nice when a gown can be put on or a sheet can be used to cover the person, but when you have an unconscious patient, the priority is airway, breathing, circulation, etc. In a shocky patient, you might have only minutes to head off an irreversible downward spiral. Getting labs and scans and doing a detailed assessment outweigh all other considerations. This goes double when the patient is unable to communicate. This has to happen in just a couple of minutes.

An MVA serious enough to cause a closed-head injury may have caused significant internal damage below the neck as well. This is especially true with an unconscious patient who can't tell ED staff where it hurts. Even conscious patients may be in shock or so jacked up on adrenalin that they don't experience normal sensation. I've been on EMT calls where I got cut or scratched and didn't even feel it until things began to settle down.

Yes, ED staff ought to be as respectful as possible of personal modesty, and it's good to have a reminder from the patient's perspective now and then, but removing trauma patients' clothing is more about doing a thorough examination than trying to embarrass anyone.

I hope your girlfriend had a quick recovery.

[madashell]

Well, you definitely are in the nursing profession. You have given me the same line others have without answering my questions, or understanding the true concern. First off, IF there is a need to have a patient completely naked, I have no choice but to go along with it. The BIG issue here is that not only was she stripped naked, but was left in a room with a glass front, curtain there but opened, and easily viewable by the public. Nobody could possibly convince me that this was anything but wrong. She had no choice but to put her trust in the people who were taking care of her, and they abused the trust placed in them by putting her on public display. My question was "who do I complain to?".