Tell me if this is the norm in your er!

I have a few techs where I work that I would let suture a family member, but that is because they are Army medics and do that kind of thing. Any of the others, no thanks.

Now that is not policy where I work that they let techs suture or RN's give lido. Both are done by mid level providers or higher.

Dunno. I'm not that up to date on what happens down at Pres. UNM stopped only because Centers for Medicare wouldn't reimburse for it under the existing billing categories, and they wouldn't (of course) add a code to allow for billing it accurately. It became a legal issue then, because the present billing codes assume that a mid-level or MD/DO did the sutures. So technically it was a fraud to bill it when the suturing had been done by a tech. Or some such. I wasn't directly involved, so I may have some details wrong.

I learned to suture as a military medic 30+ years ago. It's mechanical skill, easily tought, learned, and performed. I lost count of the number of sutures I've put in over the years. There are some locations that due to apearence should have someoen who is will to take on the liabilty do no matter what the skill level. Lips, eyebrows, and things like that. During later years as an RN, I've close after many a surgery. Now like has been stated here, it's a billing issue.

As to the wouldn't cleaning, the betadine that we used to use was shown to possibly cause tissue damage, Not only is it common practice to use only saline now, but there is also limits to "pressure washing" also. In some of the remote environments I still work in just using clean "not sterile" tap or filtered water to wash the dirt away is all I get, and my wound infection rate is the same as in the city with big bottles of saline. It's def an improvment over teh duct tape ane bag balm the farmers and ranchers used.

CraigB - My husband also learned to do sutures when he was an Air Force medic years ago! He also said that he, like you, would never do sutures on a face either.

As a side note, he said at that time, that the military medics were allowed to do more than the civilian RN's working the base hospital.

do you seriously want to know the norm in my er?
lets go back to when you got to the er (my er), first you would have to come with a referral leta since it is a "teaching hospital' according to them,if you dont have that you would be advised to go seek help from somewhere else,even if u do hav a referral leta, you would hav to wait in line and mark my words "wait in line in your car in the parking lot" till theres a bed space since we have only 36 beds in our er,so it doesnt matter that you got to the hospital,u still may not get help. lets assume u beat all these hurdles,every lac, no mater how small are sutured in the "theatre" by the doctors,we dont have techs here (who eva they),u dont wana know the payment protocol. the is no prefence for dead,living,partially living or dying patients. compare this to what you have over there...............

Well, yes and no. The core medical training is highly skill and protocol based. If this, then that kind of mentality. Remember, you typically have less than six months to pump out an entry level military medic. In addition, many medics have what are called ASI's or additional skill identifiers. This typically requires an advanced school. For example, the ASI M6 is for an LPN. They attend an intense year long course to obtain the M6 ASI. However, they are still considered medics first, with an ASI as a practical nurse. So, it is a bit misleading saying medics can do more, simply because you have providers with little to extensive education and experience, who all considered "medics."

Also remember that military medics do not typically share the nursing philosophy. They have more in common with with a physician. See a problem fix the problem. This physician extension like concept was one of the elements that went into the development of PA education in the 1960's. Military medics were the prototype students for many of these new programs. Therefore, the military medics scope of practice if you will is not dictated by a nurse. (Such as the case where you have a tech and delegated skills to the tech) Typically, a physician or midlevel provider in the case of medics working with a PA at a BAS will be responsible for allowing the medic to perform skills and training the medic.

In addition, not every medic sutures. The medics role in the military is highly dependent on the unit, and the unit's mission. When I was assigned to a combat arms company, I spent more time shooting and doing MOUNT exercises than providing direct medical care. However, when I worked for a field artillery unit BAS, I was able to provide more advanced care.

Finally, remember the legal implications, billing implication, and liability in the military is significantly different from the civilian world.

True; however, we cannot hold you to the same standard as the USA. You most certainly are attempting to improve the healthcare environment; however, comparing this suture situation to your situation is difficult if not impossible given the profound differences between the health care environment of our two countries.

GilaRN - Thanks, that was interesting. When hubby wakes up, I'll have to ask him about the training levels. This was 30+ years ago, during the Viet Nam war. He worked on a base hospital in the ER at night.

We have a tech in our ED who does all of the splinting of limbs. He actually knows as much, if not more than the physicians regarding orthopedics. I guess its possible to thoroughly train staff to suture wounds. I can't imagine a hospital spending that amount of time and money to do this. I also have never known a physician that would trust a tech to suture a patient. I believe this person(s) were making this up. What if there is a lac to the lip? This is a delicate procedure that needs a professional trained hand.