" We need to get a picture of your heart, so we are going to place stickers on your chest and around your left breast."
Don't be weird about it. Just be professional.
If you feel funny about doing them, then that is projected to them, and then they WILL feel weird.
Yeah, echoing your "don't be weird about it." 110%
I'll explain everything I'm doing but I also explain that the BP cuff is going to squeeze hard so remain still, and I explain the IV placement, and I warn them about "a couple bumps".
Your explanation about how you put on a 12 lead shouldn't feel any different than anything else you're explaining.
This is just us doing our job. NBD (for us)
I take this even further and trace on myself exactly where the leads are going to go with my fingers as I tell them this. I try to be as unambiguous about it as possible.
I also make a point to say that I will try to keep them as covered as I can during the process, and that I'll make sure to cover them completely as soon as I'm done.
Articulate everything that's going on, let them feel as in control of the situation as possible, people tend to be much more compliant when they know what's going on.
I find it's usually the male providers that feel more uncomfortable with it than the pt. My elderly pts usually make jokes about 'everyone else has seen them, so go for it!' Or 'modesty left after I had kids!'
Even the younger female pts have been fine with it. I think a lot of it is how you come off. And talking to your pts.
Most of the time, I work with a female partner, and they just jump in and do them all anyway because they're looking to become paramedics.
Them tig bitties ain't gonna move themselves.
No seriously, I ask if they've had one before and I explain the process to them, including why the stickers have to run along left bitty so it's not as awkward.
If they have a hijab or burka on, I'm getting a female to do it. 9/10 it's what is preferred amongst the Muslim community, in my experience.
I saw a video where a Muslim woman explained it in the context of going to a dentist. If a female provider is not available, it is okay for her to remove her hijab in front of a male provider so that he may render care. On our side, we should treat that pateint with the upmost respect and professionalism possible, and provide the means of coverage whenever we can and remove unnecessary responders from the room.
I work in a heavily Muslim area and it's rarely been an issue. I've had more grown men uncomfortable that my female partner was touching or speaking to them than women refusing to let me or a male partner treat then on religious/modesty grounds.
Good point. I haven't had this issue come up. We don't have the largest Muslim population in my area.
We do have one specific Pt though that has special dispatch instructions to only send male providers. It's honestly for everyone safety.
Eh, it really depends. I've got Bengalis, Yemenis, and Bosnians in my city and I pretty much only see the "conservative patriarchal Muslim" stereotype amongst the Yemanis (and even then it's not remotely universal).
I don't disagree, I just don't see where I suggested anyone deserved less. "Remember to treat the patient with the upmost respect" is along the same lines of "scene secure", it should be consciously remembered every call.
That said, one way we can treat a patient with respect is to better educate ourselves on religions and cultures outside of our own, as the methods by which we may demonstrate respect may vary.
Don't worry, you didn't suggest it, they just wanted to be offended and feel considered since a religious/cultural minority that will typically be mistreated was being discussed ;)
I enjoyed it, I concentrated more on biostatistics. I like math and big picture solutions. Done a handful of EMS related projects with it, but ultimately I will leaving EMS (hopefully) soon to work in a career better utilizes it.
Absolutely. My SO (who happens to be my partner when we are both on a truck), had always asked women to either lift their own breast or uses the back of his hand if they aren't capable or don't understand for some reason. He explains everything he is going to do step bybstep before he does it. And he teaches his male students this as well. Never had a problem.
Agreed, the male is usually more understanding if he knows there is no other choice. In cases like these: I do not exclude him from any part of the process including the explanation.
Can the male alternatively be a firefighter, because the only time I ever had a hijab issue was a rollover MVC where she was bleeding heavily from a head lac, and absolutely refused to take it off, despite my attempt at explaining. Firefighters show up, and it comes right off, no questions asked
never seen a women have an issue with it as long as you’re professional about it. only time in my experience there was an issue was a women in a hijab but you can’t fight religions and beliefs
Consent. Back of hand. Limit exposure and staff present.
I've never had anyone complain, and I've been doing Paramedicine since 1996.
I've only been embarrassed once, and that was with an older woman, well endowed, who asked if I liked what I saw, and she told me that she had work done, and gave me the name of the surgeon. After the call, she contacted one of my co-workers, and asked them for my number. I didn't call her.
I should probably clarify. I was in my early 30's and she was about 10 years older. I was also working for the police department as a Paramedic. Department would have frowned upon it had I called her.
Lol, I had a 50 year old unzip her top and whipped them out. I offered a towel explaining I didn't need her that exposed. And she said she just had them done and was showing everyone.
If someone is a little embarrassed or reluctant I just take an extra moment to explain simply as most understand what is going on.
I think also the other area to consider is larger bellies on bigger people. My experience is that men and women are both more keen to cover themselves up and it's just something to consider, having a blanket or let them know they can pull their shirt down when done.
I had an instructor hold the back of his hand out and say "assessment" then turn it over to a cupped hand and say "assault"....he just repeated it a few times so it sets in
Had a SOCOM military medic riding with us one day for part of his training. They don’t have any experience on an ambulance prior to coming to us. Asked if he wanted to help with the 12 lead….this man straight up grabbed the pts nipple and lifted her boob up out of the way lmao. Thankfully she didn’t really react how you’d expect one to, but man that shit was hilarious in the moment. I wish I could have seen the look on my face when he did that. I explained the proper way after the call of course
Except for those (usually more along in years) patient who have been dual blessed with large anatomy, and a comorbidity of gravity. Have had patients where I do the back of the hand and lift method, and there is literally flesh spilling over all sides of my hand. In those instances I’ve found moving them with a “slide” upward along the chest with an open hand and closed fingers is seems much less intrusive. Trying to keep a layer of fabric like shirt seems to help too.
A lot of commenters explained clinically how to go about lead placement. Nobody really mentioned your affect though. If you’re awkward, they feel awkward. Go at it like an order of business objectively and professionally. Explain first where the electrodes go while motioning with your hands on your own body, gain consent, then go about business. Continue the patient interview while you’re placing the leads so they have something else to focus on. Asking them about their presenting chief complaint is a good distraction.
I found a bit of humor can bring levity to an uncomfortable situation. "Now before you get to slappin me I gotta put these stickers on your chest to take a look at your heart, is that cool with you and your momma?"
The grannies eat that shit up they think it's so funny
That works really well on most old timers, especially since they are usually the most willing to expose themselves to you anyway and open with jokes of their own.
I would probably keep it much more professional with young/middle adults, seems to be the demographic with the most embarrassment.
don’t touch without saying what you’re doing. say why you’re putting stickers on them, where the stickers are going to go and what you need the patient to do to get them there. nothing eases someone’s mind like knowing what to expect
This is the biggest thing I try and explain to the newer medics. Fuck it gets old having to remind young adults about how you should explain shit rather than just start lifting a shirt. Thank you Nurse Catgirl.
As someone who is not EMS but has had more ECG’s than I can remember, this is the way. Explaining things is so much better. Even if I’ve had a ton I feel way better when someone explains then the awkward silence of the new guy just putting stickers on me. Even if I know it’s a good distraction and knowing helps.
Also I’ve had a male once or twice have me remove my bra but let me keep my shirt on. Then he just just moved my shirt as little as needed. Way better then the ladies who have me take it all the way off and give me the tiny napkin stuff.
You get napkins? Never once have I been given anything to... preserve a modicum of modesty. Including a stress test on a stationary bike at my cardiologists, uncomfortable on several levels, as well as new nightmare fuel - topless at the gym.
Once I was stupid enough to go to my doctors in a dress, EKG needed doing, dress was in the way, so I had to take it off, as well as my tights and bra... which left just my underwear. Never again.
I'm at the point where I don't care much anymore, less so in emergency situations, but I'd like to avoid near completely nudity when possible.
(Context: Norway is more relaxed to nudity/nakedness than the USA)
Exactly what I was going to say. Having emergency ECGs done as a 20y/o female, I very quickly came to appreciate the male medics and nurses who professionally kept me covered as much as possible while doing what needed done, explaining and not making a big deal out of it.... versus the females who would just pull my clothing/gown/sheet off and manhandle me (funny how that seems the best expression I can think of...).
I've had countless ekgs. The ones in the ambulance just lift my shirt/bra and put the stickers as needed, in the er they tell you take your bra and shirt off and put the gown on
They're probably uncomfortable because you're uncomfortable. This is a clinical procedure, not a date. Practice explaining what you're going to do in front of a mirror and ask yourself if that's a tone and face you'd trust in your personal space.
"Its just a titty baby" -a patient to me while I was in clinicals
Be professional about it and explain where the leads go and if you can then use the back of your hand to lift the breast. Using the back of your hand makes it harder for them to say your grabbed it.
Try telling that to Sharon who just got the full post divorce settlement cougar starter pack, including bolt ons. There was no way she wasn't going to show them off.
That room had 42 ceiling tiles. Three were cracked.
I’ve honestly never had to take a patient’s bra off. I’ve been able to adjust the bra or my lead placement and keep them as covered as possible throughout the process
As a woman I am shocked at how many of my male partners do not understand how bras work - they LIFT the breast tissue up people! Use this to your advantage. KEEP THE BRA ON, lift the left shoulder strap and voila the exact spot for V4 gets exposed. No cupping, lifting, fondling, or exposing required.
Ask permission, then explain EVERY SINGLE THING you are doing, and stay medical terminology. If they push back on permission (teens almost always did) just explain that you are professional (try not to giggle when you say that) and that you are just doing what is medically necessary to help them. Backup plan is blind placements using palp under a sheet which some will be ok with, because they don't care about being touched, but instead, do care about being seen.
The opposite can happen though of "YES PLEASE" which always got me rolling. Usually grannies or recent divorced. Got one or two of those from men for groin injuries.
If they refuse - document the refusal and work with a 4 lead and let the hospital deal with tit. Patients can refuse any portion of care, from transport to IV.
If they are able I just ask for them to lift themselves out of the way. Most are cool with that, and are able to keep themselves modest while I place leads. Otherwise I explain what I have to do, and use back of a gloved hand and keep them as covered as possible. Currently in a fortunate position where I have a female partner so we just split 12 leads down that line.
Not in EMS but I am a female who has recently had a few ECGs done.
Just don’t make it awkward and make the offer to have a female put it on if available. Some of us may have sexual trauma and prefer another woman to put on the leads but don’t necessarily want to ask, so if available, I’d offer.
Most of the time, we get that medical things have to be done. We can’t ignore the girls either. Stay professional and comfortable. It’ll translate to the patient.
Get consent and use medical terminology to distance yourself. “I need to put some stickers around your left breast for a picture of your heart. Is that okay or would you prefer I find a female provider?”
Most of the time they don’t care if you’re professional.
I mean, if you're using medical terminology, then it'd be something like, "I need to place some adhesive electrodes around your distal left breast to obtain a tracing of the electrical activity in your heart. Is that permissible or would you prefer I locate a female electrocardiography technician to perform the test instead?"
I exaggerate, obviously, but I actually feel that using a script much like the one you suggested is better because medical terminology often confuses patients and there's no need to "distance yourself" if you're being professional.
A quick “we need to put these stickers on your chest so we can see what’s going on with your heart” is always appropriate.
Almost all patients can cover themselves with their hands and not interfere with lead placement. I also explain why we’re doing it and where the leads will go before I start if the patient (regardless of gender) seems uncomfortable.
Haha sounds like you’re making it weird bro. They’re just tits. Most women know what to expect when getting an ekg.
Of course there are outliers and cultural exceptions.
In my experience, male providers (including me) make a bigger deal out of this than the women. Most just don't care at all, because they know it's a medical thing and they have called us for help. They have other things on their minds.
If you are too timid and make it weird, some will completely take of their top and give you a snarky comment. So don't do that.
"I need to put some stickers on you to take a little look at what your heart is doing.
They go in the middle of your chest and underneath your left breast, okay? "
Totally reasonable question. I'm of the opinion the perceived awkwardness of a situation like that (or asking about ED meds or anything that makes us potentially uncomfortable) is largely based on how uncomfortable you seem to the patient.
We are professionals, I have to move your breast because it is in the way of me doing my job and taking good care of you.
The more it is obvious that those are the driving forces behind you doing those things, patients understand. Just be professional.
Oh yeah, back of the hand. Cupping? Straight to jail. Right away.
As a pt w large breasts who’s had ECGs in emergent situations, this:
>>They go in the middle of your chest and underneath your left breast, okay?
That’s all you need to say, male or female provider. That tells us exactly where we’re going to be touched. Box checked, safety assured.
Explain what you're doing clearly, and use the back of your hand as much as possible (i.e. large chested woman, if you need to 'lift' a breast to get the lead in place, do not use the palm side of your hand)
Goes for any touch in "sensitive" areas - if you can, use the back side of your hand so it is clear you are not trying to grab. Not always possible, palpating for injury may require otherwise, but as before, explain what you're doing and why.
Previous-EMT now in med school having to teach all the other male book nerds how to act around pretty girls.
I think the biggest thing is coming off as “this is just routine.” If you are all business, they’ll reflect that; it’s an understanding that this is not a personal thing, it’s entirely procedural and this is “just what we do.” However, if you are uncomfortable, I think pts feel that as well. Say, “I’m going to need to place some of these stickers on your chest, so we can take a picture of your heart. I’ll need to lift your shirt a bit.” Use the back of your hand to move a breast out of the way or ask the pt to lift their breast — I’ve always just used the back of my hand. Always run the leads up from the bottom of their shirt and if you feel the temptation to stare at something, stare at the monitor. You’ll be fine.
Stop being awkward. That’s what makes it inappropriate. You’re a medical professional!! It’s necessary!! Ask her to move her breasts as needed or use the back of your hand and explain what you’re doing. Get the ECG done and stop overthinking it. They’re probably uncomfortable because you’re making such a big deal about it which makes it a sexual thing instead of a medical thing. Calm down.
You’re a brand new EMT and by your own admission you’re very young. You’re just going over the top in your awkwardness and I think that would make even the most confident women feel a bit uncomfortable. There’s great advice in this thread but you’re going to be doing thousands of ECGs and need to not overthink it.
You're likely more uncomfortable than most of your patients.
Ask them if they've had the procedure before, explain that you need to attach the stickers to their chest around/under the left breast. Lift the breast tissue with the back of your gloved left hand while you place the leads.
Like any procedure; Be professional/clinical, explain what you're doing (the *informed* part of consent), expose enough to place the leads, but no need to bare the entire chest.
Don't pussyfoot around about it and place the leads properly. A bra doesn't necessarily need to come off but lead 4 will probably need to be under the cup/underwire , and leads 5 & 6 will probably need to be under the band. Use your landmarks and don't worry about it and it will be less uncomfortable.
“Have you had an ekg before?”
“No”
“ok well it’s basically a quick picture of your hearts electrical activity. You’ll just have to hold still for 15 seconds. I’m going to put 10 stickers on you, 2 on your shoulders, 2 on your hips, and 6 from the middle of your chest to underneath your left breast. They’re basically surrounding your heart, does that make sense?”
*after leads are places*
“how does it look? Can you see my murmur? Am I dying?”
“I can’t tell because you won’t put your fucking phone down for 10 seconds…”
As long as you are respectful and professional, which it sounds like you are, you're doing great. Keep doing what you're doing.
Story time: in the dark ages when I was an EMT, I had this female medic who was a RAGING C-U-Next-Tuesday. She was rude to patients and her partners. I distinctly remember we had a patient who was a s*xual a$sault survivor who needed an EKG. She didn't want to remove her bra, but this medic made a huge deal about lead placement. She made this woman, who was having SOB and 10/10 chest pain, cry.
I. Was. Livid.
I did the EKG with the patient's bra on and under a sheet to preserve her modesty as much as possible. Told my partner that any EKG is better than none and that we'd have had it 3 minutes ago if she hadn't been busy making women cry. This lady was having an Inferior MI.
Our patients' dignity and health are our absolute priorities as providers. As long as you're doing your best to safeguard both, you're being the best EMT you can be.
Unfortunately in an "emergency situation", you dont always get to pick the provider that shows up to help you. 99.9% of the time, if someone is having real chest pains or symptoms that need an EKG, they dont give AF who you are, your race, gender, or anything else. They just want help. I have NEVER encountered a female pt that gave two flying f's that I was a male providing her treatment and placing electrodes.
Most patients don't care. The only thing weird about it is you acting weird about it. If you are clinical and professional about it, it won't be weird for the patient.
As others have mentioned: "I'm going to take a picture of your heart by placing some stickers on your chest and under your left breast". I have never had anyone push back with that line. Almost all women don't even care if their titties are out. Still try to maintain modesty, but honestly, they will tell you they don't care and to just do what you need to do.
One time while doing a 4 lead (rural EMS and it's all we had, don't judge me.)
Probably 55 year old female, ROUGH country miles, patina, you get it. She's wearing a fucking moo moo. If ya don't know what a moo moo is, it's a one piece modest sleep dress that usually goes to the knees. Sometimes the neck hole is wide, usually pretty tight around the arms.
I go to put the top pads on, no problem. She's tripodding, so I go in to place the lead on her left side through the arm hole.
He tits are so saggy I literally can't tell what's stomach fat or titty and I'm fishin' in the dark here.
I stick the lead to what I'm pretty sure is her rip cage (she's also overweight mind you).
I look at the monitor, something is fucky. So I start checking the leads and she goes "do you want that on my sides or my fuckin' tit?" In the most haggard, smoker voice you could imagine.
I was able to peel the lead away and reattch it. I got some shit for that one.
Ask for consent, most of the time and as long as it’s appropriate, women don’t care and as you said, try to maintain their modesty as best as possible.
I have had issues involving other cultures, mainly Muslim (there was a large community near where I used to work) where the males in the household could be very obstructive and protective of their wives. I could usually talk to them and get them on side but on a couple of occasions I actually got the husband to place the leads under my guidance, not ideal but it worked and both husband and wife were more comfortable with the situation.
The more weird or awkward you are about it, the more it is for them too.
Honestly there’s nothing awkward about it. It’s a medical procedure being carried out by a professional. Explain the process quick before starting, and the more direct and professional you are about it, the smoother it goes.
I always ask if they have a bra or sports bra on under their shirt prior too starting, and explain that the stickers need to go basically right along where the wire sits in a bra. Ask them to lift up their breast and by extension their bra and place the leads underneath. Again explain, they may have to continue to hold their breast up during the acquisition if the tracing isn’t clean otherwise. If at any point they need help or you need to adjust slightly, explain first, then lift with the back side of your hand.
Personal preference here--please do not use the phrase "take a picture", "take a picture of your heart/chest", or "have a look at your chest". Ain't no fucking camera coming out. Please say "12 lead" or "EKG".
With proper explanation and consent most patients are calm and collected, but I've had enough nervous patients visibly react to "take a picture". It is murderously cringey. I do not have a huge laundry list of "rules" on my truck, but that one is nonnegotiable.
My line is “I have to put a bunch of stickers on your chest” do V1&V2 “now these ones go right where the underwire on your bra is, pardon my reach for a second” and I just slip the stickers on under the bra, moving boob when necessary. “This last one is trickiest because it sorta goes right between” then place V3.
Granted, I’m female, so no one cares. But that’s how I’d want someone to explain it to me (hence why I explain it that way)
Like a lot of people have said, keep it professional! Explain what is going on, why you are doing an EKG, what the process entails, and why the process is the way it is. Educated patients are often more comfortable patients. Also, the best piece of advice I ever received in regard to a male placing leads on a female, "the front of the hand is assault, the back of the hand is medicine."
After explaining where the leads go, give them the option of holding their own breast up while you place the stickers. If they allow you to do it, or if you're in the field and they're in no condition to do it themselves, ALWAYS push the breast up with the back of your hand/wrist. It feels more clinical and less grabby. And beyond that, do your best to hide anxiety about it. If you are calm and professional, it will go over a lot better than if you are getting squirrelly about it.
Idk what kind of patients y’all are working with. Round these parts I unzip the bag to get out the pads, turn around and half the time she’s got the girls out waiting.
i agree with the other comments about being sure to explain the procedure and why the lead placement is what it is, but I also wanna add that the way you move a breast to place a lead is important. I’ve seen male EMTs just grab and move them but I find it’s a lot more clinical and less uncomfortable if you use the back of your hand to push up the underside of the breast in order to place lead 4.
As both a medic and a lady with boobs; just don’t be weird about it. As soon as you make it weird or make it known you’re uncomfortable, it becomes uncomfortable for us too. You’re a medical professional, we expect you’ve seen and had to lift boobs before to place EKGs or preform other treatments. Every woman you come across has boobs, I’m not the first or last pair of boobs you’ll see in your career. 🤷♀️
It's only a boob mate.
Explain what you need to do, lift it up, stick them on, and be done.
If you're cool about it the patient will be. Wringing hands, uming and arring will make them feel nervous.
Dorsal, done right. Palm, prison. Don’t make it weird or else it will be weird, it’s that easy. Explain what you’re doing a why. Ask them to move their breasts if they seem uncomfy
First couple times were weird. Me being a southern bashful guy it felt weird asking little old ladies to lift their shirt up. What I didn’t know is the older they get, the less of a crap they give. But as many others have said, just explain what you’re doing, why you’re doing it, and be professional. Confidence is key.
Honestly, in my brief 2 years on an ambulance I’ve never had a problem just saying “I need to life up your shirt and put some stickers on so I can take a picture your heart, okay?”
If you convey that this is standard and you know what you’re doing then patients will be comfortable. The only time I take extra precautions is with minors and SA victims.
You being awkward about it will make it a million times more awkward. Do it confidently and they won't think twice about it. You're a goddamn professional my man.
Honestly, just be calm and professional, explain what you're doing fully, if they seem uncomfortable definitely ask if they'd prefer to have a female or second person in the room. I've never had an issue working in the field as long as I explained it. I often would demonstrate on myself with my hands where the leads needed to go while explaining if they weren't familiar. Most patients likely know what it entails. Realistically just remember it's part of your job and take a deep breath and be confident in your skills.
Idk about urgent care but ems we brake them titties out in the back of the ambulance. Most of the time the chest pain is more concerning than the exposure to two people :) also depends on the pt
One day, you'll have seen so many tits you start to think of them more as chest flesh. Everybody has flesh on their cheat. Some guys have bigger tits than some girls. If you're weird about girls, why aren't you being weird about guys.
Stop thinking of titties as sexual objects. Think of them for their utility. They feed babies. Aside from that, they serve no purpose. Tips are not as pretty when you think of them more like feminine tools.
"I need to get an ekg to rule out a heart attack. That means I need to put electrodes on your chest. Can you lift up your left breast, so I can do that?"
One time I had a girl wearing a dress with nothing underneath. I expected her to pop her left arm out but she went all in and threw her whole dress off. I was eye level with a thick brown bush like, okay. I guess we're doing this now. I just quickly ran the 12lead and told her to get dressed. Pretty sure modesty is non-existent in many people. You'd be surprised how many women actually jump at the chance to flash a dude some tit.
I also say "I have to place some stickers under your shirt. The stickers I am placing will show us what your heart is doing". Then I place the stickers being sure to use the back of my hand when I have to move her breast. Never had a problem. The shift I work normally has five guys working and no females. And there is only one female that work at my station and she works a different shift.
I always explain what I'm about to do why I'm about to do it and why it's important and ask for consent
To move a boob I use the backside of my hand
I only had it happen once in a Muslim community that I was refused to do a 12 lead but if a female Co worker is present I usually let/make her do it.
As others have said, you should always explain it that you're doing and why, use the back of the hand, ask them to lift, etc etc...
But also don't make it any more awkward than it has to be. People can FEEL that awkwardness and while it would be naive to suggest there never be any awkwardness, it should still seem like a routine medical procedure that you've done a hundred times... because it is.
It also helps if you ask if they've ever had an EKG before. It's easier to explain and less awkward if you can say "ok so you know that I have to BLAH Blah blah..."
It doesn’t have to be awkward but it can be. In the urgent care setting if you can match genders, great. If not just be confident and professional. Also, offering them a gown or sheet to cover up with if they need to remove clothing to give you access can be helpful, e.g. I see you’re wearing a dress, that’s going to require disrobing your top half. Would you like a gown or sheet and a minute or two before I start? I need to place stickers under your left breast and arm.
Be deliberate and confident after you’ve explained what you’re going to do, get it done do it right and move on. If you feel awkward they will feel awkward.
Explain the procedure and get consent, most of the time they won’t give a crap, I’ve done hundreds of 12s and have never had any issues, if I’m working with a female partner and I’m attending i will offer to the pt that my female counterpart can step in and still have never had an issue or anyone say they prefer a female yet, i find that when the patient needs a 12 lead the last of their worries is you seeing/placing stickers under their breasts. Just be professional about it, it’s part of the job
Edit: also, your age shouldn’t matter if you carry yourself with professionalism and explain why you’re doing what you’re doing, you’ll be fine!
It also helps for me most I deal with regularly are grannies. They've done it enough and I built up my ability to be professional and recognize that my tone sets the tone. This comes as someone who's autistic and is deathly afraid of creeping out a woman. I've learned to just trust that my professionalism is the changing point that makes me not creepy.
That said, I also am pretty good at catching that something doesn't feel right, and when that feeling comes up, you try to get a female witness.
Like others have said, talk then through it, explaining what you're doing and why. Using the back of your hand is good. If you're pulling their shirt up, allow it to still cover them somewhat, also putting another layer between you and their skin.
Never hesitate to get a chaperone if either of you feel it necessary. Most of time, I would EKG while a nurse would start a line, but there were times I was alone. Also, check your policies book, make sure you're covered there. In our unit, I often played chaperone for our female providers, but I was never required to have one. This day in age, that might change.
Good luck, with experience you'll develop your own system, that works for you.
That's why I'm glad my partner is a female, but I do usually ask my female patient(when conscious) if they would rather have my partner place the leads.
I use a female provider for that if possible, but otherwise, I just explain what I am doing and ask for consent before I start. If there is a secret to doing it, I would say it is don't look uncomfortable when you ask.
Besides, imagine it from their perspective. "I know you are sick, and this test can help us figure out what is going on, but I don't want to touch your boobs....so...."
As someone who's autistic with very little female contact I get this. I learned in maternity clinical though the trick is that, generally, YOU make it awkward or not. I remember when I started I felt very awkward about walking into a pt room to get vitals only to find them breastfeeding. I learned, fortunately very quickly, that if you just say "my apologies I'll be back in 30 mins, and bow out, all is well. You are the professional. Thus when you act nervous, the pt gets nervous. If you treat it like a necessary medical intervention, it'll be perceived as such.
Like others said, get consent, explain what you’re doing, use the back of your hand, and act professional. The only other thing I would mention is to cover them back up once everything is in place! Stickers on, shirt down, then start the ecg
Back of the hand to slide the boobage out the way. Be professional, explain what you're gonna do, make sure its okay. If you act nervous and weird, you're gonna make it weird.
What everyone else said. Explain the procedure and act confident in what you are doing. When I am explaining the procedure I also like to add “unfortunately I am going to have to get a bit personal to get the stickers placed correctly”. Just a small bit of levity goes a long way. I generally have found older women and women with a bunch of kids will just rip their shirts off as soon as I say I have to do an ECG with them saying “I’m old/I have kids, this nothing that lots of people haven’t seen before”. I did have a female partner once who didn’t want to move the boob and literally put the lead on the nipple😂
I usually ask the patient to move their breast. Not only does it make it more comfortable for them by keeping their privacy, but it frees up my other hand and makes it easier for me.
I always say “alright ma’am, I need to get a good look at your heart with the monitor, so we have to put a bunch of stickers on you. Some of these will be around/below the left breast. Is that ok?”
I’ve never had a patient tell me no and I’m positive it’s because I’m upfront and honest. If I have to move something myself, I always use the back of my hand and get the stickers on quickly. Never once had an issue.
If I’m having chest pain idgaf. I’ve had plenty of invasive procedures. Pap smears, ECGs, etc. The only time I’ve ever been uncomfortable is during an echo when the tech was really awkward and he seemed uncomfortable, which made me uncomfortable. Just act as if it’s any other procedure: you tell the person what you’re going to do, get consent, and explain what you’re doing during the procedure. Treat the person like a person, don’t overcompensate :)
Say this "Ok ma'am I'm about to place a 12 lead that will help us take a better picture of your heart, that means I'm gonna place a couple stickers here *jestures to sternum on myself* and a few more under the left breast *jestures to approximate placement on myself*, ok?"
Say it with confidence because you're doing it for a legitimate medical reason not cause you're a pervert. Literally never had an issue.
I explain what I am doing, offer them to assist by lifting their breast up. If they’re frail or cannot do themselves I use the back of my hand and PUSH the breast out of the way.
Female emt here. If I notice a female is conservative when it comes lead placement, I'll explain the leads do need to placed nipple line, mid axillary and one in between. Ill use a pillow case to atleast cover them up. You can ask them to lift their own left breast if they can.
I pull the shirt up taut against the bottom of the tiddy then push it out of the way with the back of my hand using the shirt as a barrier between hand and tiddy
You get used to it. Just be professional and courteous, explain the procedure to them, and let them know you'll need to place some stickers under their left breast. Generally never a problem.
We have to do our job. I always say to women that I am going to have to get a little personal with them. I try to go through the collar for v1/v2.. Then just back hand the rest. Be confident, professional, and just do it. Pull the shirt back down when you are done with placement.
When doing a 12 I ask every patient regardless of gender, “can I do an ECG, it’s essentially a picture of your heart”
If they agree, I follow with “I’ll need to place a bunch of stickers all over your chest”.
I’ve never had any feelings of awkwardness from any patient using this approach.
On the other hand I’ve witnessed partners over or under explain where the electrodes are going and the patients discomfort is quite visible.
I’m a woman so I can’t relate to the same feelings of awkwardness, but it still can feel a bit awkward. I just ask if they’ve had one before. If not, I explain what I’ll do and I explain the whole process. I’ll tell them exactly where I’m putting each sticker as I go.
There have been times I’m requested to do it since I’m usually the only female provider, which I have no problem doing, so I’d say to also be open to bringing in a female provider for patient comfort. I’ve never felt bothered by going out of my way to do anything for patient comfort. I’ve helped female patients get dressed or undressed, been the only one to enter a bathroom to assess them, been the only one to talk to domestic/assault victims, sat in the back with a male provider just to be a female presence, etc, and I just consider it giving good patient care. Never feel bad about bringing in a female provider if that’s what you and the patient feel is best.
But overall, I don’t think most patients mind a male provider. I’ve had way more patients tell me they’ve had kids and the whole world has seen everything they have to offer by now and have zero shame, than have minded. I still laugh remembering the time a male medic asked me to perform a 12 lead bc he felt awkward, and the old lady ripped off her shirt and said she’s had 6 kids and is in her 80s and has breast implants so she doesn’t care who sees what anymore. Never seen someone’s face go so red so fast.
It’s always gonna feel awkward but like most have been saying it’s inevitable if you gotta do it you gotta do ur just explain to them what you’re doing and if they’re more comfortable with a female doing them or if they’d like a more women in the room while you do it. But yea for the most part it’s always gonna be awkward (atleast for me it is haha)
Honestly the back of the hand method should be thrown in the trash for a conscious and alert patient. 10/10 times it's better to ask them to lift and hold their own left breast. Also frees up both of your hands for faster lead placement. If they can't follow those instructions, sure -- use the back of your hand.
It’s only weird if you make it weird.
Be straightforward. Ask if they’ve ever had a 12 lead before, if not, then explain it to them.
Adult women appear to be pretty used to medical exams and procedures with their body as there’s so much more that they have to be concerned with. You are just another medical professional performing another procedure. Ask if they want any of their family or friends to be present.
There is almost never a reason to expose a breast completely or remove a bra.
Am female with a bad ticker, and have also put 12 leads on many humans with bad tickers and truly the less awkward and more just matter of fact and professional you are, the more comfortable in my experience both personal and speaking with others, the patient usually is. Barring certain situations such as religious customs or things like that of course. So just be professional and treat it like it’s just a part of your job and not this big awkward moment and you should be fine!
In addition to what everyone else said here, whenever I get uncomfortable at work, I try to talk myself through it. I ask myself some questions: What’s the source of the discomfort? What can I do on my end? What will remain unchanged? Can I ask for help? Sitting with discomfort and looking at it critically can help shift your mindset
Also: for various reasons, I (a woman) prefer not to be touched by men outside my family. Handshakes and that sorta thing are a no go. But I’ve never had any issues when a male medical provider had to touch me to render care (in this regard, I’m lucky. Unfortunately, many women don’t have the same experience). Most of them will talk me through what they’re doing, which is always appreciated.
If you have the option of having a chaperone, you always need a chaperone.
It's as much for your protection as it is theirs. Don't be weird about it and don't make a big deal of it. Just explain it normally like you would any other part of your assessment and ensure you have their consent before you touch anything.
Female EMT here. Women are very used to having male medical folks in our lives. Don’t worry, just be respectful and use the back of the hand. Don’t make creepy comments. It’s all good.
I work 911, i just explain what I'm doing, and where the leads are going, and why. I've never had any issues. That being said, always make sure you move the breast with the back of your hand, and don't expose someone more than necessary. If they really have an issue with a male doing it, they'll speak up, especially in a non emergent setting.
Have them lift their left breast with their right hand over the shirt. Pull the bottom of the shirt on the patients left side up until it folds over the hand, exposing the area where you're going to place your electrodes. Place electrodes. Put the shirt back down, have them relax their arms. Boom. Didn't expose any more than a bathing suit would and you had all your landmarks to place your electrodes (because it does matter friends)
I tell them the same spiel every time, “ok there’s ten stickers. One on each arm and leg, two on your sternum and four under your left breast. I want you to know where my hands are going before they get there so you don’t think I’m getting fresh with you.”
If wearing a shirt, go up the shirt & back hand the titties out the way for the lower stickers. No, don't smack them, use the back side of the hand to lift them out the way.ive also explained to patients where I need to sticker, and if they would care to move their breast up for me.
I kind of mastered tucking the patients shirt under the breast/creating a barrier between my hands and their skin. Keeps most of the breast covered and I still get my ECG.
Talk and act professionally. Your title allows you to treat them so you need to do it confidently.
Never an open hands on the boob, can ask the pt to hold them if they could.
Obviously discomfort/or they ask, then get someone else but realistically be respectful ask them to move things if needed and use the back of your hand. There are to many patients realistically
Just let them know what you're doing. Be matter of fact and honest. In my experience, if you're professional, polite, and informative, the vast majority of women don't really care if you see their breasts in this context. Most of my patients have had 12 leads done before, so they're not usually surprised by the procedure.
I honestly never ran into an issue with this. Just inform them of what you're about to do and if you're okay with it, then go from there. Go as fast as you can and get it over with if they consent. If you're lucky, you'll have a female partner to cover these problems. I loved my last co-ed partner because she always teched the sensitive female calls.
It's gotta be quick and with as little contact as possible. Do what's necessary to get the leads on right but that's it. And make sure you let them know what you're doing beforehand so they feel safer and more secure while you're doing it.
" We need to get a picture of your heart, so we are going to place stickers on your chest and around your left breast." Don't be weird about it. Just be professional. If you feel funny about doing them, then that is projected to them, and then they WILL feel weird.
Finishing your quote with “is that okay?” to definitively place with them the power of consent seems to help too.
☝️Bingo!
Yeah, echoing your "don't be weird about it." 110% I'll explain everything I'm doing but I also explain that the BP cuff is going to squeeze hard so remain still, and I explain the IV placement, and I warn them about "a couple bumps". Your explanation about how you put on a 12 lead shouldn't feel any different than anything else you're explaining. This is just us doing our job. NBD (for us)
I take this even further and trace on myself exactly where the leads are going to go with my fingers as I tell them this. I try to be as unambiguous about it as possible. I also make a point to say that I will try to keep them as covered as I can during the process, and that I'll make sure to cover them completely as soon as I'm done. Articulate everything that's going on, let them feel as in control of the situation as possible, people tend to be much more compliant when they know what's going on.
I'm so glad that I'm not the only one who does that!
I find it's usually the male providers that feel more uncomfortable with it than the pt. My elderly pts usually make jokes about 'everyone else has seen them, so go for it!' Or 'modesty left after I had kids!' Even the younger female pts have been fine with it. I think a lot of it is how you come off. And talking to your pts. Most of the time, I work with a female partner, and they just jump in and do them all anyway because they're looking to become paramedics.
1000% this. Any touch can feel professional or creepy depending on how it’s done and your confidence.
Them tig bitties ain't gonna move themselves. No seriously, I ask if they've had one before and I explain the process to them, including why the stickers have to run along left bitty so it's not as awkward. If they have a hijab or burka on, I'm getting a female to do it. 9/10 it's what is preferred amongst the Muslim community, in my experience.
I saw a video where a Muslim woman explained it in the context of going to a dentist. If a female provider is not available, it is okay for her to remove her hijab in front of a male provider so that he may render care. On our side, we should treat that pateint with the upmost respect and professionalism possible, and provide the means of coverage whenever we can and remove unnecessary responders from the room.
I work in a heavily Muslim area and it's rarely been an issue. I've had more grown men uncomfortable that my female partner was touching or speaking to them than women refusing to let me or a male partner treat then on religious/modesty grounds.
Good point. I haven't had this issue come up. We don't have the largest Muslim population in my area. We do have one specific Pt though that has special dispatch instructions to only send male providers. It's honestly for everyone safety.
I'm a Medic in Amish Country in Southeastern PA, I've had the exact same experiences with them. as well.
Disobeying males not really in their wheelhouse
Eh, it really depends. I've got Bengalis, Yemenis, and Bosnians in my city and I pretty much only see the "conservative patriarchal Muslim" stereotype amongst the Yemanis (and even then it's not remotely universal).
Every patient should be treated with the utmost respect & professionalism (& dignity), respect levels shouldn’t vary based on patient religion
I don't disagree, I just don't see where I suggested anyone deserved less. "Remember to treat the patient with the upmost respect" is along the same lines of "scene secure", it should be consciously remembered every call. That said, one way we can treat a patient with respect is to better educate ourselves on religions and cultures outside of our own, as the methods by which we may demonstrate respect may vary.
Don't worry, you didn't suggest it, they just wanted to be offended and feel considered since a religious/cultural minority that will typically be mistreated was being discussed ;)
Yeah, I got some "all lives matter" energy from the comment.
EMT with an mph, how was that? I’m finalizing my sophas app this week for some online programs.
I enjoyed it, I concentrated more on biostatistics. I like math and big picture solutions. Done a handful of EMS related projects with it, but ultimately I will leaving EMS (hopefully) soon to work in a career better utilizes it.
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Say goodbye to your DM’s
Hope you're ACLS certified to work a code on your DMs.
And don’t forget to lift with the back of your hand.
You can ask her to lift her breast. That has been my experience.
Absolutely. My SO (who happens to be my partner when we are both on a truck), had always asked women to either lift their own breast or uses the back of his hand if they aren't capable or don't understand for some reason. He explains everything he is going to do step bybstep before he does it. And he teaches his male students this as well. Never had a problem.
Unless you get ROSC then just tiger claw it aside.
salt unwritten fuzzy squash skirt brave squeeze cooperative doll abounding ` this message was mass deleted/edited with redact.dev `
Was not expecting to read "fifth intercostal space" and "titty" in the same sentence
A/k/a the Fitty Intercostal Space
Yes. My post is made with the assumption that the reader knows proper placement. It is not meant to be a detailed lecture.
This is Reddit
towering close existence simplistic intelligent rotten mighty north public strong ` this message was mass deleted/edited with redact.dev `
In my experience as long as the male of the house is present, your usually good. Sadly I only have 5 women who work for me.
Agreed, the male is usually more understanding if he knows there is no other choice. In cases like these: I do not exclude him from any part of the process including the explanation.
Can the male alternatively be a firefighter, because the only time I ever had a hijab issue was a rollover MVC where she was bleeding heavily from a head lac, and absolutely refused to take it off, despite my attempt at explaining. Firefighters show up, and it comes right off, no questions asked
Brother. 😂😂😂
never seen a women have an issue with it as long as you’re professional about it. only time in my experience there was an issue was a women in a hijab but you can’t fight religions and beliefs
Consent. Back of hand. Limit exposure and staff present. I've never had anyone complain, and I've been doing Paramedicine since 1996. I've only been embarrassed once, and that was with an older woman, well endowed, who asked if I liked what I saw, and she told me that she had work done, and gave me the name of the surgeon. After the call, she contacted one of my co-workers, and asked them for my number. I didn't call her.
We had a woman in a retirement home who called for chest pain just so that she could flash us.
I should probably clarify. I was in my early 30's and she was about 10 years older. I was also working for the police department as a Paramedic. Department would have frowned upon it had I called her.
Reasonable. Out of curiosity, would you have called back if you met in a different time/place?
She was very attractive from what I remember. So probably.
Consult with a veterinarian about proper lead placement on a cougar.
If the cougar becomes aggressive, they can be calmed with wine and a day spa voucher.
😂😂
Lol, I had a 50 year old unzip her top and whipped them out. I offered a towel explaining I didn't need her that exposed. And she said she just had them done and was showing everyone. If someone is a little embarrassed or reluctant I just take an extra moment to explain simply as most understand what is going on. I think also the other area to consider is larger bellies on bigger people. My experience is that men and women are both more keen to cover themselves up and it's just something to consider, having a blanket or let them know they can pull their shirt down when done.
Just remember this little rhyme when lifting a boob: *Back of hand* = 12 lead *cupped hand* = felony
Back of hand equals 12 lead-y Cupped hand equals felony
Felon-lead-y?
I had an instructor hold the back of his hand out and say "assessment" then turn it over to a cupped hand and say "assault"....he just repeated it a few times so it sets in
Was waiting for this. Often found wearing gloves helped and chuck a towel over after.
Had a SOCOM military medic riding with us one day for part of his training. They don’t have any experience on an ambulance prior to coming to us. Asked if he wanted to help with the 12 lead….this man straight up grabbed the pts nipple and lifted her boob up out of the way lmao. Thankfully she didn’t really react how you’d expect one to, but man that shit was hilarious in the moment. I wish I could have seen the look on my face when he did that. I explained the proper way after the call of course
Fuck I don’t know if I could’ve kept it together lmao.
Dude you need to warn me before you make me laugh that hard holy shit. Im not trying to wake up everyone within a mile.
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ASSESS DON'T MOLEST
Back of the hand = 12 lead Cupped hand = felony
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The rhyme is supposed to be between 12 lead and felony. Not quite a rhyme but at least the syllables match I guess?
Except for those (usually more along in years) patient who have been dual blessed with large anatomy, and a comorbidity of gravity. Have had patients where I do the back of the hand and lift method, and there is literally flesh spilling over all sides of my hand. In those instances I’ve found moving them with a “slide” upward along the chest with an open hand and closed fingers is seems much less intrusive. Trying to keep a layer of fabric like shirt seems to help too.
*shove upward* "Can you hold this for me?"
throw them over the shoulders.
cupped hand doesn't automatically make it a. felony. its pinching/rubbing the nipple that takes it over the line.
I always just ask for consent
Pretty good policy for most things really.
A lot of commenters explained clinically how to go about lead placement. Nobody really mentioned your affect though. If you’re awkward, they feel awkward. Go at it like an order of business objectively and professionally. Explain first where the electrodes go while motioning with your hands on your own body, gain consent, then go about business. Continue the patient interview while you’re placing the leads so they have something else to focus on. Asking them about their presenting chief complaint is a good distraction.
I found a bit of humor can bring levity to an uncomfortable situation. "Now before you get to slappin me I gotta put these stickers on your chest to take a look at your heart, is that cool with you and your momma?" The grannies eat that shit up they think it's so funny
That works really well on most old timers, especially since they are usually the most willing to expose themselves to you anyway and open with jokes of their own. I would probably keep it much more professional with young/middle adults, seems to be the demographic with the most embarrassment.
don’t touch without saying what you’re doing. say why you’re putting stickers on them, where the stickers are going to go and what you need the patient to do to get them there. nothing eases someone’s mind like knowing what to expect
This is the biggest thing I try and explain to the newer medics. Fuck it gets old having to remind young adults about how you should explain shit rather than just start lifting a shirt. Thank you Nurse Catgirl.
As someone who is not EMS but has had more ECG’s than I can remember, this is the way. Explaining things is so much better. Even if I’ve had a ton I feel way better when someone explains then the awkward silence of the new guy just putting stickers on me. Even if I know it’s a good distraction and knowing helps. Also I’ve had a male once or twice have me remove my bra but let me keep my shirt on. Then he just just moved my shirt as little as needed. Way better then the ladies who have me take it all the way off and give me the tiny napkin stuff.
You get napkins? Never once have I been given anything to... preserve a modicum of modesty. Including a stress test on a stationary bike at my cardiologists, uncomfortable on several levels, as well as new nightmare fuel - topless at the gym. Once I was stupid enough to go to my doctors in a dress, EKG needed doing, dress was in the way, so I had to take it off, as well as my tights and bra... which left just my underwear. Never again. I'm at the point where I don't care much anymore, less so in emergency situations, but I'd like to avoid near completely nudity when possible. (Context: Norway is more relaxed to nudity/nakedness than the USA)
Exactly what I was going to say. Having emergency ECGs done as a 20y/o female, I very quickly came to appreciate the male medics and nurses who professionally kept me covered as much as possible while doing what needed done, explaining and not making a big deal out of it.... versus the females who would just pull my clothing/gown/sheet off and manhandle me (funny how that seems the best expression I can think of...).
I've had countless ekgs. The ones in the ambulance just lift my shirt/bra and put the stickers as needed, in the er they tell you take your bra and shirt off and put the gown on
They're probably uncomfortable because you're uncomfortable. This is a clinical procedure, not a date. Practice explaining what you're going to do in front of a mirror and ask yourself if that's a tone and face you'd trust in your personal space.
A clinical procedure, not a date! 😂🤣🤣🤣
What? Some of the kids I work with are so young they see a big ole pair of bitties and their first instinct is that it must be lunchtime.
"Its just a titty baby" -a patient to me while I was in clinicals Be professional about it and explain where the leads go and if you can then use the back of your hand to lift the breast. Using the back of your hand makes it harder for them to say your grabbed it.
Same. It’s the old ladies who don’t give a fuck
Thankfully, it's also typically the old ladies that need them.
You mean the ecg's right? Right? 🤣
.... yes 😶🌫️
The old ladies or the ones with like 5 kids that say "I'm used to it"
I’ve got 4 kids and I’m 49. Not sure how I’d feel however I respond to humor well lol
Thats understandable, and even when I do get the patient that says that I still keep it professional and expose as little as possible.
I always make the patient hold it up. Plus and I’ll die on this hill, the bra doesn’t always need to come off.
Try telling that to Sharon who just got the full post divorce settlement cougar starter pack, including bolt ons. There was no way she wasn't going to show them off. That room had 42 ceiling tiles. Three were cracked.
bolt ons. im fucking dead
I’ve honestly never had to take a patient’s bra off. I’ve been able to adjust the bra or my lead placement and keep them as covered as possible throughout the process
As a woman I am shocked at how many of my male partners do not understand how bras work - they LIFT the breast tissue up people! Use this to your advantage. KEEP THE BRA ON, lift the left shoulder strap and voila the exact spot for V4 gets exposed. No cupping, lifting, fondling, or exposing required.
Ask permission, then explain EVERY SINGLE THING you are doing, and stay medical terminology. If they push back on permission (teens almost always did) just explain that you are professional (try not to giggle when you say that) and that you are just doing what is medically necessary to help them. Backup plan is blind placements using palp under a sheet which some will be ok with, because they don't care about being touched, but instead, do care about being seen. The opposite can happen though of "YES PLEASE" which always got me rolling. Usually grannies or recent divorced. Got one or two of those from men for groin injuries.
If they refuse - document the refusal and work with a 4 lead and let the hospital deal with tit. Patients can refuse any portion of care, from transport to IV.
Be clinical not creepy
If they are able I just ask for them to lift themselves out of the way. Most are cool with that, and are able to keep themselves modest while I place leads. Otherwise I explain what I have to do, and use back of a gloved hand and keep them as covered as possible. Currently in a fortunate position where I have a female partner so we just split 12 leads down that line.
Not in EMS but I am a female who has recently had a few ECGs done. Just don’t make it awkward and make the offer to have a female put it on if available. Some of us may have sexual trauma and prefer another woman to put on the leads but don’t necessarily want to ask, so if available, I’d offer. Most of the time, we get that medical things have to be done. We can’t ignore the girls either. Stay professional and comfortable. It’ll translate to the patient.
Get consent and use medical terminology to distance yourself. “I need to put some stickers around your left breast for a picture of your heart. Is that okay or would you prefer I find a female provider?” Most of the time they don’t care if you’re professional.
I mean, if you're using medical terminology, then it'd be something like, "I need to place some adhesive electrodes around your distal left breast to obtain a tracing of the electrical activity in your heart. Is that permissible or would you prefer I locate a female electrocardiography technician to perform the test instead?" I exaggerate, obviously, but I actually feel that using a script much like the one you suggested is better because medical terminology often confuses patients and there's no need to "distance yourself" if you're being professional.
Good point. A balance between “whip em out” and a lecture on mammary glands would be best. Professionalism is the real key.
A quick “we need to put these stickers on your chest so we can see what’s going on with your heart” is always appropriate. Almost all patients can cover themselves with their hands and not interfere with lead placement. I also explain why we’re doing it and where the leads will go before I start if the patient (regardless of gender) seems uncomfortable.
Haha sounds like you’re making it weird bro. They’re just tits. Most women know what to expect when getting an ekg. Of course there are outliers and cultural exceptions.
In my experience, male providers (including me) make a bigger deal out of this than the women. Most just don't care at all, because they know it's a medical thing and they have called us for help. They have other things on their minds. If you are too timid and make it weird, some will completely take of their top and give you a snarky comment. So don't do that.
Exactly. It’s just a medical procedure.
"I need to put some stickers on you to take a little look at what your heart is doing. They go in the middle of your chest and underneath your left breast, okay? " Totally reasonable question. I'm of the opinion the perceived awkwardness of a situation like that (or asking about ED meds or anything that makes us potentially uncomfortable) is largely based on how uncomfortable you seem to the patient. We are professionals, I have to move your breast because it is in the way of me doing my job and taking good care of you. The more it is obvious that those are the driving forces behind you doing those things, patients understand. Just be professional. Oh yeah, back of the hand. Cupping? Straight to jail. Right away.
As a pt w large breasts who’s had ECGs in emergent situations, this: >>They go in the middle of your chest and underneath your left breast, okay? That’s all you need to say, male or female provider. That tells us exactly where we’re going to be touched. Box checked, safety assured.
Explain what you're doing clearly, and use the back of your hand as much as possible (i.e. large chested woman, if you need to 'lift' a breast to get the lead in place, do not use the palm side of your hand) Goes for any touch in "sensitive" areas - if you can, use the back side of your hand so it is clear you are not trying to grab. Not always possible, palpating for injury may require otherwise, but as before, explain what you're doing and why.
Previous-EMT now in med school having to teach all the other male book nerds how to act around pretty girls. I think the biggest thing is coming off as “this is just routine.” If you are all business, they’ll reflect that; it’s an understanding that this is not a personal thing, it’s entirely procedural and this is “just what we do.” However, if you are uncomfortable, I think pts feel that as well. Say, “I’m going to need to place some of these stickers on your chest, so we can take a picture of your heart. I’ll need to lift your shirt a bit.” Use the back of your hand to move a breast out of the way or ask the pt to lift their breast — I’ve always just used the back of my hand. Always run the leads up from the bottom of their shirt and if you feel the temptation to stare at something, stare at the monitor. You’ll be fine.
Stop being awkward. That’s what makes it inappropriate. You’re a medical professional!! It’s necessary!! Ask her to move her breasts as needed or use the back of your hand and explain what you’re doing. Get the ECG done and stop overthinking it. They’re probably uncomfortable because you’re making such a big deal about it which makes it a sexual thing instead of a medical thing. Calm down.
Lol how about you calm down, I’m a brand new EMT, it was a simple question
You’re a brand new EMT and by your own admission you’re very young. You’re just going over the top in your awkwardness and I think that would make even the most confident women feel a bit uncomfortable. There’s great advice in this thread but you’re going to be doing thousands of ECGs and need to not overthink it.
You're likely more uncomfortable than most of your patients. Ask them if they've had the procedure before, explain that you need to attach the stickers to their chest around/under the left breast. Lift the breast tissue with the back of your gloved left hand while you place the leads. Like any procedure; Be professional/clinical, explain what you're doing (the *informed* part of consent), expose enough to place the leads, but no need to bare the entire chest. Don't pussyfoot around about it and place the leads properly. A bra doesn't necessarily need to come off but lead 4 will probably need to be under the cup/underwire , and leads 5 & 6 will probably need to be under the band. Use your landmarks and don't worry about it and it will be less uncomfortable.
Remember to always grab with a squeezing motion using both hands, while smiling, as to not offend the patient.
Name fits
“Have you had an ekg before?” “No” “ok well it’s basically a quick picture of your hearts electrical activity. You’ll just have to hold still for 15 seconds. I’m going to put 10 stickers on you, 2 on your shoulders, 2 on your hips, and 6 from the middle of your chest to underneath your left breast. They’re basically surrounding your heart, does that make sense?” *after leads are places* “how does it look? Can you see my murmur? Am I dying?” “I can’t tell because you won’t put your fucking phone down for 10 seconds…”
As long as you are respectful and professional, which it sounds like you are, you're doing great. Keep doing what you're doing. Story time: in the dark ages when I was an EMT, I had this female medic who was a RAGING C-U-Next-Tuesday. She was rude to patients and her partners. I distinctly remember we had a patient who was a s*xual a$sault survivor who needed an EKG. She didn't want to remove her bra, but this medic made a huge deal about lead placement. She made this woman, who was having SOB and 10/10 chest pain, cry. I. Was. Livid. I did the EKG with the patient's bra on and under a sheet to preserve her modesty as much as possible. Told my partner that any EKG is better than none and that we'd have had it 3 minutes ago if she hadn't been busy making women cry. This lady was having an Inferior MI. Our patients' dignity and health are our absolute priorities as providers. As long as you're doing your best to safeguard both, you're being the best EMT you can be.
Unfortunately in an "emergency situation", you dont always get to pick the provider that shows up to help you. 99.9% of the time, if someone is having real chest pains or symptoms that need an EKG, they dont give AF who you are, your race, gender, or anything else. They just want help. I have NEVER encountered a female pt that gave two flying f's that I was a male providing her treatment and placing electrodes.
I do not consider religion, I treat everyone.
Most patients don't care. The only thing weird about it is you acting weird about it. If you are clinical and professional about it, it won't be weird for the patient. As others have mentioned: "I'm going to take a picture of your heart by placing some stickers on your chest and under your left breast". I have never had anyone push back with that line. Almost all women don't even care if their titties are out. Still try to maintain modesty, but honestly, they will tell you they don't care and to just do what you need to do.
One time while doing a 4 lead (rural EMS and it's all we had, don't judge me.) Probably 55 year old female, ROUGH country miles, patina, you get it. She's wearing a fucking moo moo. If ya don't know what a moo moo is, it's a one piece modest sleep dress that usually goes to the knees. Sometimes the neck hole is wide, usually pretty tight around the arms. I go to put the top pads on, no problem. She's tripodding, so I go in to place the lead on her left side through the arm hole. He tits are so saggy I literally can't tell what's stomach fat or titty and I'm fishin' in the dark here. I stick the lead to what I'm pretty sure is her rip cage (she's also overweight mind you). I look at the monitor, something is fucky. So I start checking the leads and she goes "do you want that on my sides or my fuckin' tit?" In the most haggard, smoker voice you could imagine. I was able to peel the lead away and reattch it. I got some shit for that one.
"your fuckin tit, ma'am."
Ask for consent, most of the time and as long as it’s appropriate, women don’t care and as you said, try to maintain their modesty as best as possible. I have had issues involving other cultures, mainly Muslim (there was a large community near where I used to work) where the males in the household could be very obstructive and protective of their wives. I could usually talk to them and get them on side but on a couple of occasions I actually got the husband to place the leads under my guidance, not ideal but it worked and both husband and wife were more comfortable with the situation.
Tell them to lift and cover their own tit if they can. If they can't then explain everything and use the back of your hand lol
The more weird or awkward you are about it, the more it is for them too. Honestly there’s nothing awkward about it. It’s a medical procedure being carried out by a professional. Explain the process quick before starting, and the more direct and professional you are about it, the smoother it goes. I always ask if they have a bra or sports bra on under their shirt prior too starting, and explain that the stickers need to go basically right along where the wire sits in a bra. Ask them to lift up their breast and by extension their bra and place the leads underneath. Again explain, they may have to continue to hold their breast up during the acquisition if the tracing isn’t clean otherwise. If at any point they need help or you need to adjust slightly, explain first, then lift with the back side of your hand.
Personal preference here--please do not use the phrase "take a picture", "take a picture of your heart/chest", or "have a look at your chest". Ain't no fucking camera coming out. Please say "12 lead" or "EKG". With proper explanation and consent most patients are calm and collected, but I've had enough nervous patients visibly react to "take a picture". It is murderously cringey. I do not have a huge laundry list of "rules" on my truck, but that one is nonnegotiable.
My line is “I have to put a bunch of stickers on your chest” do V1&V2 “now these ones go right where the underwire on your bra is, pardon my reach for a second” and I just slip the stickers on under the bra, moving boob when necessary. “This last one is trickiest because it sorta goes right between” then place V3. Granted, I’m female, so no one cares. But that’s how I’d want someone to explain it to me (hence why I explain it that way)
Like a lot of people have said, keep it professional! Explain what is going on, why you are doing an EKG, what the process entails, and why the process is the way it is. Educated patients are often more comfortable patients. Also, the best piece of advice I ever received in regard to a male placing leads on a female, "the front of the hand is assault, the back of the hand is medicine."
After explaining where the leads go, give them the option of holding their own breast up while you place the stickers. If they allow you to do it, or if you're in the field and they're in no condition to do it themselves, ALWAYS push the breast up with the back of your hand/wrist. It feels more clinical and less grabby. And beyond that, do your best to hide anxiety about it. If you are calm and professional, it will go over a lot better than if you are getting squirrelly about it.
Idk what kind of patients y’all are working with. Round these parts I unzip the bag to get out the pads, turn around and half the time she’s got the girls out waiting.
i agree with the other comments about being sure to explain the procedure and why the lead placement is what it is, but I also wanna add that the way you move a breast to place a lead is important. I’ve seen male EMTs just grab and move them but I find it’s a lot more clinical and less uncomfortable if you use the back of your hand to push up the underside of the breast in order to place lead 4.
As both a medic and a lady with boobs; just don’t be weird about it. As soon as you make it weird or make it known you’re uncomfortable, it becomes uncomfortable for us too. You’re a medical professional, we expect you’ve seen and had to lift boobs before to place EKGs or preform other treatments. Every woman you come across has boobs, I’m not the first or last pair of boobs you’ll see in your career. 🤷♀️
It's only a boob mate. Explain what you need to do, lift it up, stick them on, and be done. If you're cool about it the patient will be. Wringing hands, uming and arring will make them feel nervous.
The fact you’re even asking is a worry to me.
Dorsal, done right. Palm, prison. Don’t make it weird or else it will be weird, it’s that easy. Explain what you’re doing a why. Ask them to move their breasts if they seem uncomfy
It’s the ones that very excitedly insist you do it that I’m afraid of.
First couple times were weird. Me being a southern bashful guy it felt weird asking little old ladies to lift their shirt up. What I didn’t know is the older they get, the less of a crap they give. But as many others have said, just explain what you’re doing, why you’re doing it, and be professional. Confidence is key.
Honestly, in my brief 2 years on an ambulance I’ve never had a problem just saying “I need to life up your shirt and put some stickers on so I can take a picture your heart, okay?” If you convey that this is standard and you know what you’re doing then patients will be comfortable. The only time I take extra precautions is with minors and SA victims.
You being awkward about it will make it a million times more awkward. Do it confidently and they won't think twice about it. You're a goddamn professional my man.
Honestly, just be calm and professional, explain what you're doing fully, if they seem uncomfortable definitely ask if they'd prefer to have a female or second person in the room. I've never had an issue working in the field as long as I explained it. I often would demonstrate on myself with my hands where the leads needed to go while explaining if they weren't familiar. Most patients likely know what it entails. Realistically just remember it's part of your job and take a deep breath and be confident in your skills.
Idk about urgent care but ems we brake them titties out in the back of the ambulance. Most of the time the chest pain is more concerning than the exposure to two people :) also depends on the pt
Just be professional and bring a chaperone.
If my EKG tech needed a chaperone, without a good reason, I would be the one feeling weird and probably ask them both to leave.
One day, you'll have seen so many tits you start to think of them more as chest flesh. Everybody has flesh on their cheat. Some guys have bigger tits than some girls. If you're weird about girls, why aren't you being weird about guys. Stop thinking of titties as sexual objects. Think of them for their utility. They feed babies. Aside from that, they serve no purpose. Tips are not as pretty when you think of them more like feminine tools. "I need to get an ekg to rule out a heart attack. That means I need to put electrodes on your chest. Can you lift up your left breast, so I can do that?" One time I had a girl wearing a dress with nothing underneath. I expected her to pop her left arm out but she went all in and threw her whole dress off. I was eye level with a thick brown bush like, okay. I guess we're doing this now. I just quickly ran the 12lead and told her to get dressed. Pretty sure modesty is non-existent in many people. You'd be surprised how many women actually jump at the chance to flash a dude some tit.
I also say "I have to place some stickers under your shirt. The stickers I am placing will show us what your heart is doing". Then I place the stickers being sure to use the back of my hand when I have to move her breast. Never had a problem. The shift I work normally has five guys working and no females. And there is only one female that work at my station and she works a different shift.
I always explain what I'm about to do why I'm about to do it and why it's important and ask for consent To move a boob I use the backside of my hand I only had it happen once in a Muslim community that I was refused to do a 12 lead but if a female Co worker is present I usually let/make her do it.
As others have said, you should always explain it that you're doing and why, use the back of the hand, ask them to lift, etc etc... But also don't make it any more awkward than it has to be. People can FEEL that awkwardness and while it would be naive to suggest there never be any awkwardness, it should still seem like a routine medical procedure that you've done a hundred times... because it is. It also helps if you ask if they've ever had an EKG before. It's easier to explain and less awkward if you can say "ok so you know that I have to BLAH Blah blah..."
It doesn’t have to be awkward but it can be. In the urgent care setting if you can match genders, great. If not just be confident and professional. Also, offering them a gown or sheet to cover up with if they need to remove clothing to give you access can be helpful, e.g. I see you’re wearing a dress, that’s going to require disrobing your top half. Would you like a gown or sheet and a minute or two before I start? I need to place stickers under your left breast and arm.
Be deliberate and confident after you’ve explained what you’re going to do, get it done do it right and move on. If you feel awkward they will feel awkward.
Explain the procedure and get consent, most of the time they won’t give a crap, I’ve done hundreds of 12s and have never had any issues, if I’m working with a female partner and I’m attending i will offer to the pt that my female counterpart can step in and still have never had an issue or anyone say they prefer a female yet, i find that when the patient needs a 12 lead the last of their worries is you seeing/placing stickers under their breasts. Just be professional about it, it’s part of the job Edit: also, your age shouldn’t matter if you carry yourself with professionalism and explain why you’re doing what you’re doing, you’ll be fine!
It also helps for me most I deal with regularly are grannies. They've done it enough and I built up my ability to be professional and recognize that my tone sets the tone. This comes as someone who's autistic and is deathly afraid of creeping out a woman. I've learned to just trust that my professionalism is the changing point that makes me not creepy. That said, I also am pretty good at catching that something doesn't feel right, and when that feeling comes up, you try to get a female witness.
Like others have said, talk then through it, explaining what you're doing and why. Using the back of your hand is good. If you're pulling their shirt up, allow it to still cover them somewhat, also putting another layer between you and their skin. Never hesitate to get a chaperone if either of you feel it necessary. Most of time, I would EKG while a nurse would start a line, but there were times I was alone. Also, check your policies book, make sure you're covered there. In our unit, I often played chaperone for our female providers, but I was never required to have one. This day in age, that might change. Good luck, with experience you'll develop your own system, that works for you.
That's why I'm glad my partner is a female, but I do usually ask my female patient(when conscious) if they would rather have my partner place the leads.
I use a female provider for that if possible, but otherwise, I just explain what I am doing and ask for consent before I start. If there is a secret to doing it, I would say it is don't look uncomfortable when you ask. Besides, imagine it from their perspective. "I know you are sick, and this test can help us figure out what is going on, but I don't want to touch your boobs....so...."
As someone who's autistic with very little female contact I get this. I learned in maternity clinical though the trick is that, generally, YOU make it awkward or not. I remember when I started I felt very awkward about walking into a pt room to get vitals only to find them breastfeeding. I learned, fortunately very quickly, that if you just say "my apologies I'll be back in 30 mins, and bow out, all is well. You are the professional. Thus when you act nervous, the pt gets nervous. If you treat it like a necessary medical intervention, it'll be perceived as such.
Like others said, get consent, explain what you’re doing, use the back of your hand, and act professional. The only other thing I would mention is to cover them back up once everything is in place! Stickers on, shirt down, then start the ecg
Back of the hand to slide the boobage out the way. Be professional, explain what you're gonna do, make sure its okay. If you act nervous and weird, you're gonna make it weird.
What everyone else said. Explain the procedure and act confident in what you are doing. When I am explaining the procedure I also like to add “unfortunately I am going to have to get a bit personal to get the stickers placed correctly”. Just a small bit of levity goes a long way. I generally have found older women and women with a bunch of kids will just rip their shirts off as soon as I say I have to do an ECG with them saying “I’m old/I have kids, this nothing that lots of people haven’t seen before”. I did have a female partner once who didn’t want to move the boob and literally put the lead on the nipple😂
I usually ask the patient to move their breast. Not only does it make it more comfortable for them by keeping their privacy, but it frees up my other hand and makes it easier for me.
Have a small chart made up that shows what they can do.
Always lift with the back of your hand.
Where gloves. Explain what you are doing, where the leads will be placed and why. Then ask if it is ok that you place the leads.
I always say “alright ma’am, I need to get a good look at your heart with the monitor, so we have to put a bunch of stickers on you. Some of these will be around/below the left breast. Is that ok?” I’ve never had a patient tell me no and I’m positive it’s because I’m upfront and honest. If I have to move something myself, I always use the back of my hand and get the stickers on quickly. Never once had an issue.
If I’m having chest pain idgaf. I’ve had plenty of invasive procedures. Pap smears, ECGs, etc. The only time I’ve ever been uncomfortable is during an echo when the tech was really awkward and he seemed uncomfortable, which made me uncomfortable. Just act as if it’s any other procedure: you tell the person what you’re going to do, get consent, and explain what you’re doing during the procedure. Treat the person like a person, don’t overcompensate :)
Just tell them what you're doing and why. Don't make it weird and it won't be weird
If you are just doing a 4 lead, do wrists and ankles. You expose basically nothing except sometimes having to pull down a sock a little.
Say this "Ok ma'am I'm about to place a 12 lead that will help us take a better picture of your heart, that means I'm gonna place a couple stickers here *jestures to sternum on myself* and a few more under the left breast *jestures to approximate placement on myself*, ok?" Say it with confidence because you're doing it for a legitimate medical reason not cause you're a pervert. Literally never had an issue.
I explain what I am doing, offer them to assist by lifting their breast up. If they’re frail or cannot do themselves I use the back of my hand and PUSH the breast out of the way.
Female emt here. If I notice a female is conservative when it comes lead placement, I'll explain the leads do need to placed nipple line, mid axillary and one in between. Ill use a pillow case to atleast cover them up. You can ask them to lift their own left breast if they can.
I pull the shirt up taut against the bottom of the tiddy then push it out of the way with the back of my hand using the shirt as a barrier between hand and tiddy
You get used to it. Just be professional and courteous, explain the procedure to them, and let them know you'll need to place some stickers under their left breast. Generally never a problem.
We have to do our job. I always say to women that I am going to have to get a little personal with them. I try to go through the collar for v1/v2.. Then just back hand the rest. Be confident, professional, and just do it. Pull the shirt back down when you are done with placement.
When doing a 12 I ask every patient regardless of gender, “can I do an ECG, it’s essentially a picture of your heart” If they agree, I follow with “I’ll need to place a bunch of stickers all over your chest”. I’ve never had any feelings of awkwardness from any patient using this approach. On the other hand I’ve witnessed partners over or under explain where the electrodes are going and the patients discomfort is quite visible.
I’m a woman so I can’t relate to the same feelings of awkwardness, but it still can feel a bit awkward. I just ask if they’ve had one before. If not, I explain what I’ll do and I explain the whole process. I’ll tell them exactly where I’m putting each sticker as I go. There have been times I’m requested to do it since I’m usually the only female provider, which I have no problem doing, so I’d say to also be open to bringing in a female provider for patient comfort. I’ve never felt bothered by going out of my way to do anything for patient comfort. I’ve helped female patients get dressed or undressed, been the only one to enter a bathroom to assess them, been the only one to talk to domestic/assault victims, sat in the back with a male provider just to be a female presence, etc, and I just consider it giving good patient care. Never feel bad about bringing in a female provider if that’s what you and the patient feel is best. But overall, I don’t think most patients mind a male provider. I’ve had way more patients tell me they’ve had kids and the whole world has seen everything they have to offer by now and have zero shame, than have minded. I still laugh remembering the time a male medic asked me to perform a 12 lead bc he felt awkward, and the old lady ripped off her shirt and said she’s had 6 kids and is in her 80s and has breast implants so she doesn’t care who sees what anymore. Never seen someone’s face go so red so fast.
Just remember, lift the boob with the back of your hand, not your palm.
It’s always gonna feel awkward but like most have been saying it’s inevitable if you gotta do it you gotta do ur just explain to them what you’re doing and if they’re more comfortable with a female doing them or if they’d like a more women in the room while you do it. But yea for the most part it’s always gonna be awkward (atleast for me it is haha)
Honestly the back of the hand method should be thrown in the trash for a conscious and alert patient. 10/10 times it's better to ask them to lift and hold their own left breast. Also frees up both of your hands for faster lead placement. If they can't follow those instructions, sure -- use the back of your hand.
It’s only weird if you make it weird. Be straightforward. Ask if they’ve ever had a 12 lead before, if not, then explain it to them. Adult women appear to be pretty used to medical exams and procedures with their body as there’s so much more that they have to be concerned with. You are just another medical professional performing another procedure. Ask if they want any of their family or friends to be present. There is almost never a reason to expose a breast completely or remove a bra.
Am female with a bad ticker, and have also put 12 leads on many humans with bad tickers and truly the less awkward and more just matter of fact and professional you are, the more comfortable in my experience both personal and speaking with others, the patient usually is. Barring certain situations such as religious customs or things like that of course. So just be professional and treat it like it’s just a part of your job and not this big awkward moment and you should be fine!
In addition to what everyone else said here, whenever I get uncomfortable at work, I try to talk myself through it. I ask myself some questions: What’s the source of the discomfort? What can I do on my end? What will remain unchanged? Can I ask for help? Sitting with discomfort and looking at it critically can help shift your mindset Also: for various reasons, I (a woman) prefer not to be touched by men outside my family. Handshakes and that sorta thing are a no go. But I’ve never had any issues when a male medical provider had to touch me to render care (in this regard, I’m lucky. Unfortunately, many women don’t have the same experience). Most of them will talk me through what they’re doing, which is always appreciated.
Generally if you don’t make it awkward, they don’t mind. It’s a legitimate medical diagnostic tool
If you have the option of having a chaperone, you always need a chaperone. It's as much for your protection as it is theirs. Don't be weird about it and don't make a big deal of it. Just explain it normally like you would any other part of your assessment and ensure you have their consent before you touch anything.
Female EMT here. Women are very used to having male medical folks in our lives. Don’t worry, just be respectful and use the back of the hand. Don’t make creepy comments. It’s all good.
I feel like even asking “do you want a chaperone in the room” goes a long way to help someone relax. But that’s just me tbh!
I work 911, i just explain what I'm doing, and where the leads are going, and why. I've never had any issues. That being said, always make sure you move the breast with the back of your hand, and don't expose someone more than necessary. If they really have an issue with a male doing it, they'll speak up, especially in a non emergent setting.
Have them lift their left breast with their right hand over the shirt. Pull the bottom of the shirt on the patients left side up until it folds over the hand, exposing the area where you're going to place your electrodes. Place electrodes. Put the shirt back down, have them relax their arms. Boom. Didn't expose any more than a bathing suit would and you had all your landmarks to place your electrodes (because it does matter friends)
I tell them the same spiel every time, “ok there’s ten stickers. One on each arm and leg, two on your sternum and four under your left breast. I want you to know where my hands are going before they get there so you don’t think I’m getting fresh with you.”
If wearing a shirt, go up the shirt & back hand the titties out the way for the lower stickers. No, don't smack them, use the back side of the hand to lift them out the way.ive also explained to patients where I need to sticker, and if they would care to move their breast up for me.
I kind of mastered tucking the patients shirt under the breast/creating a barrier between my hands and their skin. Keeps most of the breast covered and I still get my ECG.
Talk and act professionally. Your title allows you to treat them so you need to do it confidently. Never an open hands on the boob, can ask the pt to hold them if they could.
Obviously discomfort/or they ask, then get someone else but realistically be respectful ask them to move things if needed and use the back of your hand. There are to many patients realistically
Just let them know what you're doing. Be matter of fact and honest. In my experience, if you're professional, polite, and informative, the vast majority of women don't really care if you see their breasts in this context. Most of my patients have had 12 leads done before, so they're not usually surprised by the procedure.
I honestly never ran into an issue with this. Just inform them of what you're about to do and if you're okay with it, then go from there. Go as fast as you can and get it over with if they consent. If you're lucky, you'll have a female partner to cover these problems. I loved my last co-ed partner because she always teched the sensitive female calls.
You making it awkward is going to make it more uncomfortable than just going in and doing it
It's gotta be quick and with as little contact as possible. Do what's necessary to get the leads on right but that's it. And make sure you let them know what you're doing beforehand so they feel safer and more secure while you're doing it.