I got a request recently from a maker of trauma shears to give their product a test drive and see what I think. I’m more than happy to give their shears a few turns around the block and kick the tires a bit. Who knows, maybe they’ll be really good. Maybe they’ll be my new favorite set.
All the shears I’ve ever owned have come and gone. I don’t have a particular set that I’m really attached to right now. I’ve had some great sets of shears over the years. I think my longest running favorite pair lasted around five years. I don’t remember the brand now, but they were good. Black handle with a bit of cloth tape for grip. (I know it isn’t a bio-friendly practice.) Nice tight feel to the action.
Like all shears I eventually lost them. Some scene was moving along and I handed them off to someone in the rush of delegation to strip a patient down and they never returned. Equipment comes and goes. It’s the way of things.
The truth of the matter is, it doesn’t much matter how good or bad the shears work. The guy (or gal) wielding the shears is the deciding factor in how fast a patient gets stripped. I can strip a human in seconds with a wobbly pair of $2.00 knock-offs. The shears just don’t make that much of a difference. It really comes down to technique. Here’s the skinny on how to take a patient from their winter-best to fully naked in seconds.
Try to slip shoes off before you cut them off. Many will just come right off. If they don’t, try to slip the scissors inside the laces. This works sometimes but not often. If you can’t easily get under the laces and you’re in a hurry to lose the shoes just cut the instep.
Slid you scissors into the shoe at the medial aspect of the foot just under the ankle and cut downward into the shoe. Now pull it off. Voila! Still no luck? Make the same cut on the other side too.
Don’t try to cut a pair of pants completely off. It takes forever. The secret to rapid removal of pants and shirts is to primarily tear them off, using the scissors to get the cut going.
To get an idea what I’m talking about take a look at my highly technical drawing at right. Cut the bottom cuff of the pant leg then grab the fabric on either side of the cut and tear it. Jeans tear like gang-busters. Stretchy fabrics take a bit more work. Motorcycle leathers are a pain. You may need to actually use the scissors all the way up.
Keep the scissors handy to go through the waistband and the belt at the top.
Just like the pants, remember you’re ripping. The scissors are just giving you the assist. Don’t cut like a kid in kindergarten doing a craft. One nice cut, then tear em’ like you mean it.
If you look at my handy shirt drawing you’ll see the fast three cut pattern that even works if your patients left arm is substantially longer than their right.
Shirt fabric also bunches better than pant fabric so keep in mind that you can often save some time by grabbing the fabric you intend to cut in one big bunch and then cutting through it. You can cut a t-shirt from waist to neck by gripping it in one bunch and then cutting it.
Snip, tear, tear. Snip tear, tear. It probably goes without saying, but this is all much easier with a sharp pair of scissors. My nostalgic story aside, there’s something to be said for not getting too attached to a good pair of scissors. All of them get dull and loose after a few years of use. Some much sooner. (And there’s no faster way to dull them up than to cut up pennies for amusement.)
While this last point should be obvious, we all need to be reminded. We are granted tremendous trust from the public. There are very few instances when people are allowed to strip strangers in the middle of the street. (Except maybe in Las Vegas.) So don’t forget that it’s a three part process, strip, assess, cover. Or, when possible, strip, cover, assess. Protecting peoples dignity is part of our job as well.
I collected a few more tidbits from the EMS folks on twitter. Thanks to @Jeramedic, @DG_Medic, @RVaEMSExaminer and @RicAnderson.
- Look out for ECG wires when cutting. They’re expensive to replace. (I’ve had this happen as well.)
- When cutting the shirt, cut the collar down to avoid cutting toward the patients face and neck.
- When cutting a man’s pants, stay toward the outside seams to steer clear of sensitive anatomy. (Ouch)
- In rural areas you may want to consider cutting along the seams. Some folks who are gifted with the sewing machine will sew their clothes back up. (If you’re in downtown Manhattan don’t bother.)
- There is debate over the proper way to cut off a down jacket. My advice is to avoid it, if it is humanly possible. If you must cut through a down jacket, do it on the street, before you load the patient. If you cut up one of these pretty little fashion statements in the back of your rig you will be cleaning up feathers for weeks. No, seriously…weeks.
- Ask an officer how his or her bulletproof vest comes off before you lay into it. Most of them Velcro on the sides.
So there you have it. Everything you need to know to get the patient fully exposed in a hurry. Now go find a trauma patient and show em your stuff. But first …
Now it’s your turn: Do you have any good tips or tricks for exposing a patient fast? What techniques do you use to get the job done. What else did we leave out? Leave a comment before you move on.