Assessing female pt

[Tuxkitteh94]

Hey everyone,
I'm a fairly new EMT who just got hired with an IFT company.
This may be a weird question; may not be?
It really struck me yesterday when I was transporting my second young female patient, a 10 year old female 51/50 pt who refused to put on any bottoms or pants. I may have been negligent in my assessments with both because I didn't want to touch them/ look at them in certain places.
Any help?

 

[DesertMedic66]

What kind of assessment would you be doing for an IFT 5150 patient?

They don't want to put pants then ok I guess. As soon as they get on my gurney they are getting covered with blankets.

 

[Tuxkitteh94]

What kind of assessment would you be doing for an IFT 5150 patient?

They don't want to put pants then ok I guess. As soon as they get on my gurney they are getting covered with blankets.

At least for our company, we're required to do a head-to-toe assessment.

 

[DesertMedic66]

So if you're doing an IFT for a Fx arm you are going to do a full head to toe physical assessment?

 

[Chewy20]

Hey everyone,
I'm a fairly new EMT who just got hired with an IFT company.
This may be a weird question; may not be?
It really struck me yesterday when I was transporting my second young female patient, a 10 year old female 51/50 pt who refused to put on any bottoms or pants. I may have been negligent in my assessments with both because I didn't want to touch them/ look at them in certain places.
Any help?

Like Desert said, what exactly are you assessing? I may get flack for saying it, but I would go out on a limb and say really no IFT BLS pt needs an assessment, and that you wasting your time. Especially with a 10yo psych pt. People who are actually ill, you can run down OPQRST and AMPLE to get familiar with it, and take your required BP. Also can ask about listening to lung sounds if you want. When I did IFT the pts were more than likely in the back of an ambulance all the time and wanted nothing to do with us. So I would get what was required, look at their papers for meds and history and ask what med was for what. Not every pt needs a full head-to-toe, even in the 911 setting...Not going to do a head-to-toe because a pt is saying the have a headache, unless they are showing for other things to go along with it.

Just saw that you posted that it is required (seems like overkill) to get a head-to-toe, so you can forget about my comment.

 

[chaz90]

At least for our company, we're required to do a head-to-toe assessment.

Whoa.

That can't possibly be accurate. You should clear this up with your management, because this has bad idea written all over it. BLS psych IFTs should absolutely not be exposed for a "full head to toe assessment." An assessment tailored to the patient and situation should be performed each time, but going head to toe on pediatric psych patients who have already been fully evaluated by a higher level of care could lead to some serious questions.

 

[STXmedic]

At least for our company, we're required to do a head-to-toe assessment.

So you're assessing for femoral crepitus on every patient, despite being an absence of trauma? Your company apparently doesn't believe in common sense. I'm not saying don't provide appropriate care, but appropriate doesn't mean everybody gets every inch of them evaluated. If she's a psych, address her psych issues. Now if she's a psych and there's a recent history or evidence of trauma, then assess away.

Put a blanket on her, assess her vitals and mental state, and have a nice conversation. Done.

 

[chaz90]

If your software requires some sort of entry for each item, have you considered generic "across the room assessment" terminology?

For example, "Left arm noted to be moving purposefully without notable issues. Pt.'s complaint unrelated to arm."

Under the "genitalia" tab (if such a thing exists), I'd go with N/A if the patient is as described.

 

[RefriedEMT]

I wouldn't even bother stating anything about something that you did not DO or find out in history, cuz I was with a 911 company that did a lot of IFT and we would focus simply on what they were sent to the hospital for, whether it got better and how they are atm along with vitals, other HX and interventions. A lot of those IFT's were schizophrenic PT's of which the majority of the assessment was simply talking to them and reading their medical HX that I was given.

 

[Ewok Jerky]

Physical exam for psych patients is basically cardiac and respiratory for me, maybe a quick poke in the belly + general impression. I will do a review of systems of sorts but certainly not exposing them and doing a pelvic exam. Just by looking you can tell their skin signs, eyes tracking, equal chest rise, cuts/bruises on wrist/arms, extremities moving appropriately etc.

Cover the girl with a blanket when she gets on the gurney, attempt to keep it there as best you can. As for documentation I have never had a "required" entry for a genital exam. You obviously got to see her legs so you can document them as normal/without injury or whatever. But I have never had a psych run get kicked back for lack of completeness.

You need to careful with these patients, especially if you are male. Not just what the patient might say but what staff might think if you show up at a facility and she has no bottoms on. Any time I get a young female psych patient, I prefer (if I have one) my female partner to tech. Ask the staff if they have had any issues with inappropriate behavior with her. Document that she had "no bottoms on arrival, covered with blanket, removed by patient, attempted to replace" etc. If anything wonky starts happening make sure you keep your partner informed.

 

[chriscemt]

The only physical assessment I do on a psych transfer is if they have wounds - like slit wrists, that kind of thing. If the patient is non-compliant I don't insist on the assessment and note their non-compliance in narrative.

 

[exodus]

Hey everyone,
I'm a fairly new EMT who just got hired with an IFT company.
This may be a weird question; may not be?
It really struck me yesterday when I was transporting my second young female patient, a 10 year old female 51/50 pt who refused to put on any bottoms or pants. I may have been negligent in my assessments with both because I didn't want to touch them/ look at them in certain places.
Any help?

That patient would get 4 point restraints and a blanket over her. If she ended up becoming cooperative and agreed to not fling the blanket off I may let her have a hand free. Lots of people are against restraining 5150 peds, but I'm all for at least 2 point at the ankles on them no matter what. They're slippery little buggers and are much less predictable and don't have the mental capacity as most adult 5150's do to process what the results of their actions may be. Also, if your area allows 5150's to wear their clothing (and not paper scrubs) during transport, remember to check their pockets and waistbands for weapons or potential weapons. I've found knives on some of our 51's that come from PD before.

 

[COmedic17]

Whoahhhh.

Doing a full head-toe including genitals ( I understand you wernt purposefully trying to check genitals- but even assessing anywhere NEAR genitals) on a pshyc IFT is a law suit waiting to happen.
If there's no indication of trauma, why are you even doing a full trauma assessment?
You could do a "rapid head to toe assessment" by asking patient if they have any pain, looking for any deformities, etc. You can do most of that visually. Without even touching the patient. But if your IFT they already got a head to toe at the facility.


And even on a trauma 911 call you don't need to check every patients downstairs region. The reason you check ones "junk" is to make sure it's still there, they don't have a priapism secondary to a spinal cord injury or another issue, Check perineum for internal bleeding from pelvis break, etc. if you have a patient who tripped off a curb and broke their ankle, for the love of God, leave their junk alone.


And if its a pshyc- guess who probably wouldn't hesitate to claim sexual assault just to be a turd.

 

[Kevinf]

I would be astounded if your company really has a strip n' flip policy for IFT. Most likely they want a basic visual assessment done. Ask the patient if the have any prosthetics or medical devices in or on them, visualize or palpate the device if reasonable and mark it down... You don't need to make sure grandma's foley is inserted properly unless there you have some reason to believe otherwise. Ask about any wounds or notable injuries and do likewise. If your patient isn't competent, ask the staff... they are required to give you a report. Keep your hands off young members of the opposite sex for this type of transport when you are basically alone with them. Many or most large facilities these days require a chaperone for docs/nurses working with that sort of patient for the protection of everyone. Plenty of providers have been falsely accused of misconduct, but it's even worse if the accusation is true.

 

[Ewok Jerky]

Edit: actually maybe that's not a good idea.

 

[Rin]

Hey everyone,
I'm a fairly new EMT who just got hired with an IFT company.
This may be a weird question; may not be?
It really struck me yesterday when I was transporting my second young female patient, a 10 year old female 51/50 pt who refused to put on any bottoms or pants. I may have been negligent in my assessments with both because I didn't want to touch them/ look at them in certain places.
Any help?

What everyone else said: keep the exam appropriate to their complaint.

Now my question is, do you find you have the same problem when it IS actually necessary to deal with a female's private areas? For example, do you have a difficult time putting on EKG leads, listening to breath sounds, or palpating their abdomen?

You may just have to consciously put some effort into your professionalism. You cannot let your discomfort keep you from patient care, and you cannot let your patients see your discomfort and in turn become uncomfortable with you.

 

[RedAirplane]

I've never been in this situation, but the thread of advice I always hear is: it's only unprofessional/awkward if you make it that way.

 

[COmedic17]

I've never been in this situation, but the thread of advice I always hear is: it's only unprofessional/awkward if you make it that way.

You have clearly never has a pshyc patient try to rub one off while staring you in the eyes.

 

[Handsome Robb]

Do people really restrain every psychiatric patient on a legal hold? Talk about degrading to the patient who is calm, cool and cooperative.

 

[DesertMedic66]

Do people really restrain every psychiatric patient on a legal hold? Talk about degrading to the patient who is calm, cool and cooperative.

County and company protocol. Any patient on a 5150 (psych hold) gets 4 point soft restraints.

I'll try to avoid it with some patients on 911 calls. Had a 14 y/o girl who tied shoe string very gently around her neck because her boyfriend broke up with her. I just had the police officer meet me at the ED to finish the report so legally the patient wasn't on a hold during my care and transport.