The Art of Using Trauma Shears
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.
Shoes:
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.
Pants:
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.
Shirt:
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.
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While your rural sewing comments are for the most part accurate, don’t overlook us City slickers when it comes to saving a few bucks repairing cut pants.
Then again, I hope the reason we’re cutting the pants off so fast is to gain assessment of an injury, thus negating the future use of the pants anyway.
I would be curious to hear your thoughts about cutting bike leathers and if I really should be tearing blue jeans when a simple cut from top to bottom works so nicely.
I used to tear, but the fabrics have changed. In the big scary City we can get folks wearing 3,4,5,6 layers of clothing or, on the other extreme, expensive suits who’s owners ask us not to cut.
You’ll see on the premiere of Chronicles of EMS that I had a woman hit by a car and did not completely expose her. Yes you read that right, I did not completely expose her, nor did the ER. We used her clothing to our advantage by looking, ruling out injury and returning the clothing. Pull the neck up, look around, pull the sleeves up, look around.
Not appropriate all the time, but also no need to go flying in with the shears every time like I was taught in EMT school.
Great post as usual, I’ll check back for the tips on leathers, since I can’t assess around them and most riders, when conscious, freak when I start.
Two great insights as always Justin. Honestly I skipped the “to cut or not to cut” argument because I secretly hoped someone would bring it up in comments and we could all fight about it. (OK, that’s not true, I was being lazy) I’ve never been a crazy cutter like some folks. I like to preserve patients clothing, dignity and warmth whenever possible. I palpate hard and move clothes around. Maybe I should expose more people than I do.
Having said that, If I feel there’s an injury under there that i need to see, I shred em’ and I don’t ask. Also, muti-system/major mechanism or complex mechanism trauma gets stripped right there. Sometimes we just need to be able to see every inch, fast. You know what I’m talking about.
To rip or cut? Obviously I’m a ripper. I just think its so fast. I know some fast cutters but ripping just works better for me.
If a motorcycle rider is conscious, They’ll tell you not to cut their leathers. If the mechanism dictates, I strip them anyway. If I have the time and they are willing to bear the pain, I’ll pull them off. In moderate mechanism I’m willing to palpate hard and leave it at that. It’s always a judgement call.
But if they need to come off, I don’t waste much time debating about it. If they cost that much, bill them to your insurance.
I usually find that if I need to get someone naked fast, a couple of shots of Tequila does the trick.
…what?
Great Post!
That one was a little too easy Newt.
If you encounter a patient who’s sitting up who you know you want to completely expose, make one cut from collar straight down the back after you collar but before you board. Or hell, before you collar if you want.
That way, you lay them down, and the shirt can come off at any time, just by pulling.
I was reminded recently that patients don’t always hear what we say. My partner said to child with leg injury, “We need to cut off your dinosaur PJs to see your leg.”
Child began screaming and crying and between sobs, one word at a time he said “Don’t …. cut …. off …. my …. legs.”
Finally, the only proper way to cut off a down jacket is outside the ambulance.
Not only should you be careful of cutting ECG cords, but any BP cords, pulse ox, or even those spider straps….and when we used to use MAST trousers those were never good to cut off either…..just a thought…
Great post BTW. Thanks for the insight! I work at a race track and we can usually tell just how much pain a rider is in by wether or not they argue about us cutting their leathers. It always makes you think “oh sh*t” when they dont argue about it…..
Very useful info my friend. That was something I don’t remember ever really being explained in any class.
Here’s My advice for cutting. When treating a patient that was assaulted with a penetrating weapon like a knife or a gun shot, cut around the holes the weapon made. The clothing could end up as evidence.
There I was, earnestly taking in all of your advice, when I came across the line “even works if your patients left arm is substantially longer than their right” and looked more closely at the drawing. Actually made me laugh after a day that would have tried even Job’s patience. Thanks!
Thanks for the posts Steve. I’ve been a long time reader, love the comments too . I just want to hear what you have to say about stripping the diver who drowned and what you would have done. he had a dry suit on plus several more layers of clothing, coats, etc for insulation none the less it was thick. And that’s the other thing his dry suit costs $ 3000.00 His boss didn’t want us to cut it.
Oh, I did the down jacket in the rig once… once. Plus, the girl had those long hair extensions and we kept finding more and more hair. We still laugh about that one.
I’m loving the comment string on this post!
@CBEMT I like it.
@Greg Friese It’s hard to describe what a big mistake shredding a down jacket is to someone who hasn’t actually done it.
@ I second that thought on the motorcyclist. Is they let you cut the leather, they’re sick! (or rich?)
@Jeremiah Oh good one. I’ve learned that in evidence preservation classes and I’m kicking myself that I didn’t include it in the post. That’s why we have comments …. and you guys.
@Linda I’m glad you appreciate my poor artistic skills. I’m a better writer than an artist.
@Greg I’m a public safety diver myself. Those suits are a bear. And yes, we wear a bunch of woollies and such underneath. If the diver is dead, leave it all for the coroner and investigative team. Don’t touch their gear.
If the diver is a working cardiac arrest, (or really sick) shred it. Pull the gear off and shred the suit. Who cares what the “boss” dude says. That’s the cost of doing business. If he had a sick diver and he was worried about his suit he’s a jerk.
@Steve Yuck. I just gagged a little.
Any tips on getting the clothes out from under the patient without causing further pain or should you just leave them under the patient and work around them.
I tend to just leave the clothes under them. If they were sick enough to get the full strip treatment I don’t spend a lot of time making them look pretty.
A little late to the party but whenever possible I cut down the patient’s posterior… a slice down the center of the back, onto the pants down one leg then back up the other leg and back over to the original cut around the butt. Done right you can roll them supine and pull everything off straight up. Think how easy it is to remove a hospital gown.
Happy to have inspired such an excellently written article. Can’t wait for the review.
Great walk through on the use of this indespinsible tool!
To add to the cutting around bullet and stab holes, make sure to place the clothes in a PAPER bag for the police AFTER cutting off.
I recently started using the following shears for my stripping. its very quick and safe for the patient and makes it really hard to cut EKG lines, iv’s etc. As an added bonus they glow in the dark which helps on a crowded vehicle accident, because my shears used to get lost in my bunker pants. Additionally it eliminates the need to carry a seatbelt cutter since you can use them alone.
http://www.ripshears.com/RipShears/Products.html
Awesome post, I really like the information shared on this topic, thanks!