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.