A Randomized Comparison of Clothing Removal Techniques in a Simulated Trauma Patient Exposure

Introduction Trauma shears are commonly used by emergency medical services (EMS) providers to remove clothing from patients and expose underlying traumatic injuries. Other tools exist that may be more effective, but they are largely untested. This study compared the use of trauma shears versus two cutting hooks in removing clothing from a simulated trauma patient. Methods We recruited 18 paramedic students to participate in a cross-over study designed to remove clothing from a wholly dressed full-body training mannequin using trauma shears (with the cut-and-rip (CAR) technique) and two cutting hooks (S-Cut QE (ES Equipment AB, Nol, Sweden) and the Talon Rescue Emergency Clothing Knife (TRECK+, Talon Rescue, Farmington, CT, USA)). We determined the order of the tools using a three-by-three Latin square and randomized participants equally between possible orders to minimize carryover effects. We recorded times for total clothing removal and the removal of clothing from the upper and lower body, respectively. We employed a mixed-effects analysis of variance (ANOVA) to determine any differences between tools. Results Removal time was significantly faster with the S-Cut QE compared to the CAR technique and TRECK+ (mean 78 seconds, 95% confidence interval (CI) 52-103 vs. 142 seconds, 95% CI 117-167, vs. 209 seconds, 95% CI 184-235, p<0.001). The S-Cut QE was significantly faster than the CAR technique and TRECK+ for upper body clothing removal (mean 47 seconds, 95% CI 30-64 vs. 92 seconds, 95% CI 75-109, vs. 131 seconds, 95% CI 115-148, p<0.001) and the S-Cut QE and CAR were significantly faster than TRECK+ for lower body clothing removal (mean 25 seconds, 95% CI 11-38 and 44 seconds, 95% CI 31-58 vs. 71 seconds, 95% CI 58-85, p<0.001). Most (78%) participants preferred the S-Cut QE over other tools. Conclusion The S-Cut QE removed clothing from a simulated trauma patient faster than both the CAR and TRECK+. Emergency medical services (EMS) agencies should consider adding a cutting hook to their standard trauma kit.