Cutting Clothes

We all carry trauma shears. Of all the tools, a medic has to carry, I would say there are only three — a pen, a stethoscope and trauma shears that are essentials. I wear my stethoscope around my neck, my pen or pens in various shirt and or pants pockets, and I carry my trauma shears in a side pants pockets in the little holder space with a piece of cloth strung through one of the scissor handle loops and then snapped to keep them from falling out.*

I really can’t work without any of these three tools. I have to be able to take down information with a pen, I really need to listen to lung sounds and auscultate the BP with my stethoscope.** And I need the scissors to cut off the patient’s clothes to expose the skin and check for injury.

When I started in EMS back in 1989, the trauma chief at the local hospital insisted that any trauma brought into his trauma room be completely stripped of clothes prehospitally, and covered only with a sheet. He was of course talking about moderate to major traumas and not little fall and go booms.

I did a call once back then for an old woman who had fallen and hurt her shoulder on the church steps in winter. I was pretty certain her arm was broken, but I got my trauma scissors out to cut the coat so I could see better, but my partner Kevin stopped me. “This is probably her only coat,” he said. “Let’s see if we can’t slip it off her.” He was right. We were able to hold c-spine and still get the coat off. She had a broken arm, but she didn’t have to go buy a new coat.

In the years since, I have tried to find the proper balance between exposing what needs to be exposed, protecting the patient from potentially harmful movement and destroying someone’s wardrobe unnecessarily.

I will also say I have never used my trauma shears to cut a down coat and turn the ambulance into a tempest of feathers.

At our local hospitals, we have the right to ask for the trauma room if we think the patient merits it. Some calls (gunshot to the chest) the merit is so obvious, we don’t even have to ask for the trauma room. Others (certain MVAs) we need to request it. Sometimes, the hospital (depending on the triage nurse and doctor covering the trauma room) will give us the trauma room even when we do not ask for it.

Unless it is a major multisystem trauma, I try to cut only what needs to be exposed if I think there is an injury there. If a young woman has a broken shoulder, I will rarely cut jeans, unless my survey has elicited evidence of a pelvic or lower extremity injury as well. When I do cut the jeans, I leave the undergarments uncut unless there is an obvious injury there.

The trauma team cuts everything (in addition to poking their fingers and tubes into every possible orifice as well as creating several new ones). I feel sorry for many of my patients, particularly the ones who are alert and whose injuries might be more limited than others.

I am not in any way criticising the trauma team for doing what they do. Their mandate is to be thorough, and they are. They do not like clothes. They like naked.

It doesn’t matter to them. Clothes have no economic or sentimental value — a poor woman’s coat, a young girl’s designer jeans, an army veteran’s old unit jacket. I’ve seen veterans rip themselves out of being c-spined and take swings at the person trying to cut their army jacket. Don’t tread on me!

The trauma team doesn’t care. It’s a clothes destroying machine. An insatiable beast.

I had a call the other day. Man at work is talking to a coworker. He turns to leave, falls face forward and hits his head. Presto! He’s having a gran mal seizure. No apparent seizure history. The guy he was talking to at the time — the witness — can’t say what came first — the fall or the seizure causing the fall. He can’t say if turning caused the man to trip, if the man started to syncopize, or if he started to seize and then fell. Big Unknown. We have the chicken and egg situation.

The patient is a bloody mess. Big puddle of blood on the floor, hair is caked with blood, but the only wound I can find is a jagged laceration above his eyebrow. The man is no longer unconscious, but he is still out of it. We manage to c-spine him, and get a pressure dressing on the head lac, which is still bleeding.

In the ambulance, he is alert enough to answer questions. He knows who he is, what his birth date is, but he is unaware anything has happened to him, and he categorically rejects that he has any medical history. Never had a seizure. No history of seizures, on no meds.

I need to get a blood pressure and pop in an IV line, but the man is wearing a long-sleeved Yankees tee-shirt that I can’t roll up. If this was a straight forward seizure, I might take the BP over the shirt and try to stick an IV in the hand, but I really don’t know what this is, but I do know I need a good pressure and decent IV access because I suspect that this patient is going to wind up in the trauma room.

Sorry, I say, but I am going to have to cut your shirt. Aw, com’on, he says. It’s my Yankee shirt. Sorry, man. And I cut quickly from the wrist right up to the shoulder. I take the pressure 140/100 and pounding, and pop in an 18 in his forearm. I ask him again about medical history and if he has ever had seizures and he again tells me no. He gets more and more coherent as we approach the hospital, but continues to deny the seizure history.

When I call the hospital, they ask me if I want the trauma room. I tell them well, since I don’t know if it is a medical causing a trauma or a trauma causing a medical that means it could be a trauma, in which case I probably should be seeing them in the trauma room. Very good, see you there, they say.

I tell the man since I already cut the arm of his shirt, I might as well cut the rest of the shirt off. (Since we are going to the trauma room, I have to show I at least exposed his upper torso.) He tries to protest, but my scissors are too quick. I cut the shirt off and cover him with a sheet. I leave his new jeans on. I tell him when we get to the hospital, I am going to take him into a room where there will be a lot of doctors and nurses and other staff and they will asking him a lot of questions.

About what? he says.

About what just happened to you.

Nothing happened to me. I’m fine.

You had a seizure.

No I didn’t. Why do you have to cut my Yankees shirt?

You ever had seizures before? I ask.

No, he says, I told you that before.

They strip him in no time in the trauma room. Their shears are like a school of piranhas. (I am always careful to fully disconnect the patient from my monitor before moving him over to the trauma bed because we have lost many leads to the frenzied team. Snip. Snip. Snip. The patient is naked and where we once had four long wires, we now have three long wires and one short one.)

I give my report and then stay for a little while to repeat my story a few times because whenever a member of the team relays their version of what they heard to a newly arriving member the story morphs. I try to keep it straight. No history of seizures. Patient, who had complained of nothing during the day, talking to a coworker, ends conversation, turns, falls hits head, and then is observed having a gran mal seizure for 2-3 minutes. Posticital. Now more alert. Denies any seizure past. Chicken or egg. Your guess is as good as mine.

After writing my run report in the EMS room, I am walking back down the hall when I see the patient being wheeled to CAT Scan. “Hey,” one of the trauma team says, “He wants the guy who cut his Yankee shirt off to buy him a new one.”

“Sorry,” I say, and keep going.

What’s a Yankees shirt cost? About $15? Hey, I’m not a millionaire.

I wonder if the trauma team is ever asked for financial compensation? How many designer jeans, Armani suits, sweaters patie
‘s grandmothers made for them, and favorite old t-shirts have fallen victim to the trauma teams scissors? Have they ever thought to replace them out of their wages? I’m just a poor paramedic.

And besides, while I might be sympathetic about an old woman’s coat, when it comes to a Yankees shirt — Not!


Later after bringining in another patient to the same hospital, I stop by and see the man. It turns out I had picked up his glasses at the scene and put them in my pocket, and then forgot about them, only to discover them later. His eye is swollen shut with a huge hematoma. He says he needed twenty stitches to close the gash. They are going to keep him over night for observation. I ask him if he remembers what happened, and he says he has no recollection. And he never had seizures before, he says.

He is happy I found his glasses. I apologize about cutting his shirt. He says its okay, he was just upset because it was his Yankees shirt.

I tell him I did enjoy cutting it.

He looks at me. “You’re a Red Sox fan?”

“That’s right, partner,” I say as I quickly unholster my trusty trauma shears. “I made quick work of that shirt too.” I twirl the shears like a six-gun, catch the grip and then make lightning fast snips in the air. “A-Rod, Jeter, Posada. 26 snips for 26 championships.” I bring the scissors to my lips and blow out the smoke. “Another Yankee shirt bites the dust.”

“Ha, ha,” he says.

Good thing he has a sense of humor.


A story of another encounter with a Yankee Fan.


* Some EMTs have what we used to call “whoop” belts — holsters that attach to your belt to carry an array of tools such as trauma shears, various size scissors, a penlight or flashlight, window-punch, multipurpose tool, tape, whatever. When I started I had a small one(penlight, bandage scissors, trauma shears and window punch), but stopped wearing it after a month or so as I saw it wasn’t in fashion, and besides the penlight and trauma shears, I never needed the other stuff. I did one day at a medical conference obtain a free salesman sample of one of those reflex hammers that they use to tap against your knee. I wore that one day in the side holster as a gag.

** Once I did leave my stethoscope in the ambulance, there was none in the bag, and neither my partner nor any of the first responders had one. After I intubated the patient, I had to check for positive lung sounds by pressing my ear under the dead guy’s arm pits on each side so I could hear if my tube was good. This was pre-capnography, of course.


  • B-Rad says:

    I had a good friend who a few years ago fell while snowboarding and wearing his favorite sweatshirt, which the mountain medics had to cut off. He asked them not to, but they insisted. So instead of losing his favorite sweatshirt, he kept the scraps and then later sewed it back together. It looked horrendous, but he still had his favorite sweatshirt and a good story to tell.

  • RC Huder says:

    The evolution of the “paramedic” scissors (that is what they were called back then) to the instrument I see now in hardware stores seems strange. There were none when I started in the 1970″s just medical shears. In the early days we all carried leather pouches with a penlight, hemostats (don’t ask why I never used them}, and the medical shears. Then someone invented them and started to marketing them to us. We all added the “paramedic” scissors to our pouches and as they years went by the pouches went and only the scissors were left. When i show what they could do to people not in the business they were amazed. I will never forget the first time I saw them in a hardware store. I thought EMS had finally gone mainstream.

  • Medic 61 says:

    I’m glad to see another provider who only carries the literal essentials. I don’t need all this fancy stuff on my belt weighing me down, goodness.Besides–most of it’s on the fire engine, ambulance, or jump bag.

  • AlisonH says:

    No, no, hang on, it would have been the sweater the grandma had on that her daughter or granddaughter had knitted. My grandmother (born 1899) emphatically did not knit–that was for old ladies. Like my mom and me.Thank you for laughing with that patient. LOVE the twirling-6-gun image! And for being respectful of their clothes when you can be. I once stopped a paramedic about to rip his shears through an incredibly intricately embroidered dress on my daughter that I’d stayed up half the night to finally finish–had there been a need to, absolutely, go ahead, but–? Sure, he told me, no problem, as he put it away, don’t have to on this one.

  • AZReam says:

    we can help – with som really good neckwear 😉

  • pinky says:

    Yes a pen is a good idea. Unless you are a medical school graduate. Then invariably you can ask 16 times to borrow the nurses pen. When told you can keep the pen, refuse so you can harras the next nurse you come in contact with. I also carry Scissors. But I don’t run with them. When you need them you really really need them. And seeing that I am usually going into the OR, it is important to cut off clothes. They are ususally the same folks who insisted on wearing their own clothes in labor so I can’t say they were not warned.

  • Anonymous says:

    One unrelated question: We recently got a Type II Van and many of the ALS providers in my squad are struggling to get use to it. What are your thoughts?Before I started my field time in medic school we were all sat down and told to bring the following when we started: -The obvious clean uniform and boots, and your text books(the department prided themselves on a clean presentation)-Pen, Shears and Scope I carried that requirment with me after graduation, and picked up the belt as an ode to one of my preceptors. The belt has:-A holder for my cell-Trauma shears(in holder)-Flashlight(came to find in school nobody in the hood ever had lights in there house)-Glove Pouch(holds two sets)I think it helps to keep everything in place and has room for the radio and or pager if called for. Who knows if this will still be the case in 5,10, etc years but for now it works fine.

  • born_yesterday says:

    like any good paramedic student, i bum shears from my medics!

  • Gary says:

    Peter, Peter, Peter. There are two types of medics. Those that have cut through a down jacket and those that are in denial about it. It’s just a hazard of the job. I’ve been in EMS a lot longer than most and I still carry a fair amount of equipment. In addition to what you carry, I have an oral airway, just in case. D tank wrench, pager, gloves, keys, radio, and last but not least, handcuffs. One thing that has always annoyed me is nurses working in a trauma room and not having scissors. I’ve stopped lending mine out, because I never got them back.

  • Witness says:

    I carry shears, my scope, and a hemostat. Why a hemostat? To clamp off a colostomy bag when they break. In my jacket I also have an oral airway and most of an IV start kit.

  • PC says:

    Thanks for all the great comments.I have periodically carried some of the items you mentioned. An 02 key. When I first started I did a helicopter call and the helicopter medic couldn’t open their 02 tank. I whipped out my 02 key and handed it to him, earning a thanks. I can’t tell you the number of times since, I wish I carried one all the time. When I work in the contract time, my partners are all the time turning the 02 tank off where i like to leave it on. I get in the house and the 02 key has fallen off. Fortunately many of my partners carry the 02 keys.I had an old partner who carried a hemostat, and It came in handy on interfacility transfers when we had to carry a lot of drips. I’d hang the bags off my shirt on the end of the hemostat which was securely fastened to my shirt.A flashlight. I carried a small one when I worked at night. My partners usually have on which I always ask for when as one person mentioned you are in these houses that seem to have no working light bulbs and you are trying to get an IV on the unresponsive diabetic. Again, my partners usually carry one.Gloves- I usually carry some in my paocket, but should think about on of those pouches because i am often stuck looking at a bloody mess and have no gloves on me.What would I do without partners?On the question about the Type II vans, I prefer them because I can reach everything while seated. In the box ambulance, I have to get up to reach things.Thanks again for the comments.

  • Lethal says:

    I didn’t realize you don’t get trackbacks in your comments. What I originally said in my comment (which I also posted at my site) is that trauma shears are the bane of my existence. I’ve had my pants cut off twice because of pelvic fractures & my FAVORITE SHIRT EVER for the defibrillator.After these situations, I could only moan, “WHY ME!??”

  • Anonymous says:

    I carry only a Leatherman, pocket knife, small flashlight, work gloves and digital camera.

  • Anonymous says:

    good for u. Its one thing to strip a critical patient, but if a patient os conscious dont make them feel like a piece of meat u could care less about. I was in a car accident and a young female paramedic stripped me completely naked on scene. I was however conscious with no apparent injuries (i did have a minor concussion). Anyway she could have left my underwear on and saved me some of humiliation of having all the EMS workers and cops see me naked.

  • Anonymous says:

    I was once in a car accident and was sent to the trauma center at DCH regional. I was fully conscious and wheeled into the truama room after the paramedics revomed only shirt. A female nurse came in and told me they were going to have to cut all my clothes off. I lay fully conscious as she proceeded to strip me completely nude. With absolutely no regard for my modesty or dignity she shredded my last article of clothing( my briefs). I was stripped completely nude and strapped to a board. There was a set of double doors that led to the trauma room and the waiting room was just off trauma. I was positioned on the corner of the room so that people in the waiting room could actually see my naked genitals when the door was opened. I complained to the nurse, but she said I was imagining things and no one could see, but some young girls in the waiting room snickered eveytime the doors opened and I am convinced they saw my stripped nude body when the doors opened. This was the most embarrassing moment of m life.

  • Anonymous says:

    I can totally understand cutting the Yankee shirt off, that’s just common sense. But if a was totally conscious and they felt the need to strip me naked, especially like in the comment above mine, there would have been hell to pay. NO WAY would I have let that happen! That thoughtless nurse would have had some big problems had she treated me like that!

  • Anonymous says:

    I swear to God if I’m ever in the situation where a nurse is cutting all my clothes off and I tell her to stop and she doesn’t I would break her freakin nose! Filthy perverts!!!

  • Anonymous says:

    Gary, why handcuffs?What happens when a person absolutely refuses to have all of their clothes cut off?leemac

  • Mike Jennings says:

    While working in a trauma room were seriously injured people are taken for treatment I witnessed this scenario of the double standard of modesty for male patient many times. The first thing the medical staff do is cut all the patients clothes off to examine their entire body. A digital rectal exam is often performed to see if there is blood in their rectum and then the patient would be catheterized to obtain a sample of their urine to analyse and detect the presence of blood. This is necessary and is done to all patients male and female. Many trauma patients were involved in car accidents or were crime victims so the police would normally be involved. The police would routinely walk in the trauma room and were allowed to stand around and watch as patients, that is male patients were put through this extremely embarrassing ordeal . If the patient was a female the curtains would be immediately closed and kept closed until the entire trauma procedure was complete and the patient was covered up. If the patient was a male the curtains were always left open and the police officers which often included female officers were allowed to watch as the patient was stripped naked, under went the rectal exam and catheterized. Allowing the police especially female police officers to watch this is blatant patient abuse. This double standard of dignity for male patients is a violation of medical ethics and standards of patient dignity that are supposed to apply to everyone. If the police have a reason to enter the trauma room which they sometimes do the curtains should be closed for male patients as well. There is no excuse for the police being allowed to watch as a patient’s private parts are exposed. Many hospitals today have the police wait outside and do not allow them in the trauma room unless they have a valid reason for being there. That should be mandatory for every hospital in this country.

  • David J Cook says:

    I had small seizure, Paramedics cut my T-Shirt, cost £12.00, collectable item! 6 months later, had a even smaller seizure, cut my sleeve coat, Cost £45.99p, collectable item again and not very happy, all just to put catheter in my arm to get blood, they did not need to cut my T-shirt anyway, and I could have taken my coat off!!! there excuse is always a medical one, if you were in road accident fair enough! but I was not, and I want the money back for the damage they caused to my clothes. what can I do.

  • James says:

    When I was 21 I was in a 100 mph impact head on collision, I had injiries to face, ankle, both hands and stomach. In the ER all of my clothes were cut off, every stitch, I can understand that when you bleeding all over. There were like 10 different people in that room. But what was embarrassing was when they brought my mother and brother in the room without covering anything.

  • xx says:

    I have been reading on patient modesty and i noticed that a lot of the times these ems are doing unnecessary things to patients. It is especially distressing to read some of the comments above and how they were treated by care providers.

  • Brandi says:

    Last Saturday I had an allergic reaction to my medications my husband nor my mother in law could wake me up. They eventually called 911. What I don’t understand is why did the paramedics cut my damn tank top?! It was thinking and it was my favorite one. I hate hospitals I’d rather die in the street than go to the hospital, I was apparently only breathing once every 20 secs but why cut my thin little tank. They could’ve done what they had to without cutting one of my favorite shirts. Someone owes me a tank top!! It’s the fact that I don’t know what happened. I woke up in the hospital and started ripping the lines out of my arms. I’m scared to death of hospitals. It’s to the point I literally rather be left in the street than go to a hospital. I wake up in got lines in my arms and my fkin shirt is cut. I feel like a science experiment at that point. Someone owes me a damn shirt and no one don’t care if they saved my life, I didn’t ask for them to.

  • Tom says:

    This is reply to Eddie’s comment on December 30th. I’m kind of confused. On June June 6, 2016 at 6:29 pm. You said that you didn’t get your clothes cut off but the pulled them off and on August 16, 2016 at 12:57 am you said they placed a gown over you before they took off your undies were taking off, they covered you. Was that a different Eddie.

  • Jonathan Hirsch says:

    That is f#$@ing disgusting and unacceptable!! Did she have any valid reason for doing so,ie apparent polytrauma or couldn’t you have asked her nicely not to,protesting that you were intact and had no pain,numbness,tingling,deformity, laceration or tenderness on your body. Why didn’t you report her?

  • Jonathan Hirsch says:

    Couldn’t you have just asked her nicely not to,claiming that you had no injuries below the abdomen, if anyone did that to me without a valid cause, I would have punched them right in the face