# Suturing: legality and ethics in special scenarios



## DrScienceSpaceCat (Sep 23, 2016)

A bit of a long question, My university premed club had an event where army medics taught some of us how to do sutures and it made me think of an interesting question:

Let's say I was camping/hiking with friends and something happened that resulted in someone getting a nasty laceration (for sake of the question let's say we're lost, unable to contact any help, and don't know how long we'll be lost), I do have medical training and I have the knowledge, skill, and supplies to suture the wound closed (for sake of answering the question again let's just omit the "Just bandage/dress/clean it" answer, this particular question concerns curiosity, not actual protocol); is it illegal or unethical to suture a wound without having a proper license or certification in a situation like this?

Would the situation differ if you were suturing your own wound? 

Also would it have any negative repercussions (i.e. revocation of the cert/license) for someone who holds EMT/Paramedic/etc. seeing as suturing is out our scope of practice?

What would you do in a scenario like this? 

Thanks!


----------



## akflightmedic (Sep 23, 2016)

DrScienceSpaceCat said:


> is it illegal or unethical to suture a wound without having a proper license or certification in a situation like this?



Why would it be illegal?? I mean for sake of argument, you threw out the proper replies...so since the best standard of care was made a non-option then why would any other option be illegal for this hypothetical? Proper license...certification....well, do you think the pioneers had those? I mean someone was the first to suture, right? Not sure they had to be licensed to do so and if they did, then by whom?



DrScienceSpaceCat said:


> Would the situation differ if you were suturing your own wound?



Sure, cause I can choose to do what I want to myself, good job or bad job...it was my choice.



DrScienceSpaceCat said:


> Also would it have any negative repercussions (i.e. revocation of the cert/license) for someone who holds EMT/Paramedic/etc. seeing as suturing is out our scope of practice?



Actually it is NOT out of our scope. Unsure where you are, but suturing and just about any other skill is within our scope should a medical director ok it, train you and oversee it. I have been suturing since 2005 or so...we tend to refer out faces and hands...those are fairly specialized and/or tricky.



DrScienceSpaceCat said:


> What would you do in a scenario like this?



Ummm, I would clean it, bandage it and continue to seek help.


----------



## DrScienceSpaceCat (Sep 23, 2016)

akflightmedic said:


> Actually it is NOT out of our scope. Unsure where you are, but suturing and just about any other skill is within our scope should a medical director ok it, train you and oversee it. I have been suturing since 2005 or so...we tend to refer out faces and hands...those are fairly specialized and/or tricky.



Really? the information I've read must be faulty then (I'm from VA), perhaps it differs from state? But thanks for answering!


----------



## dutemplar (Sep 23, 2016)

My first reaction was to cringe at the question...

One, Scopes of practice differ from states and agencies and conditions.  What can be done in some enhanced circumstances (USAR/ collapse/ "Katrina" level disaster) differs from many traditional ones.  Enhanced roles and scopes of practice may differ.  Military medics do whatever the're told they can do, or justify needing to do.  Critical care paramedics may be able to suture in various situations, an EMT-B probably not.  Someone 400 miles from the nearest city in rural BFE Alaska may be allowed more than someone in downtown Anywhere USA with a hospital one mile in every direction.

Generally speaking...
Most suture kits are marked "prescription only," "prescription only," or "licensed professional use only."  If you have them in your kit, you may need to explain why and how you got them since they aren't usually for sale at CVS or Walgreens.  That's just sutures.  Injectable lidocaine, syringes, a debridement and cleansing kit?  Suturing dirty wounds is begging for infection, and doing it without numbing the area and cleaning it out is something few people are going to tolerate.  Yeah... good luck.  In some states suturing is actually considered a minor surgery and may be spelled out as to whom may do what or acting under what authority.  Practicing medicine without a license can be bad juju in both criminal and civil courts...

On duty, there may be ways to pull it off depending on your jurisdictions "exceptional situations" policies and most likely with online Command.  Most state agencies don't particularly care for "winging it" and doing what you want to.  Probably going to lose a job and a cert, even if you are trained unless you seriously dot your i's and cross your t's perfectly and have absolutely good explanations for how you acquired the supplies you most likely were not issued...

Off duty, probably considered the same as if you start an IV, intubate, or push meds on someone...

Now, if you and your buddy are out hiking, and you have a reasonable explanation for how you acquired the supplies quasi-legally from an online vendor, AND everyone is consenting, AND the medical providers that eventually take care of you don't file a complaint, AND... As far as on yourself, it can be done.  It's a little trickier to get the stitching done well and correctly and knotted neatly, but BTDT.

In all reality, it's probably easier to carry a small tube of superglue if you're looking to "wing it."  I certainly don't recommend that, and medical superglue is slightly different than the stuff at Home Depot of course.  If SHTF or the zombies break out, hey.. game on.  Suggestion though:  don't bother suturing the zombie bites.  Just apply high velocity transorbital lead implantation therapy to treat the undead infection.

Your mileage may vary.  Your state may vary.  You might care to ask the medical director and or obtain appropriate legal advice from someone more knowledgeable in your region's medical practice laws.

Side notes:  Pennsylvania, this would not be kosher except under extremesis and with online medical direction.  Maryland, this would be an exceptional call where you would be reporting to the State medical director within 24 hours.


----------



## EpiEMS (Sep 23, 2016)

DrScienceSpaceCat said:


> My university premed club had an event where army medics taught some of us how to do sutures and it made me think of an interesting question



The way to look at this is the same way I look at performing IO insertion or intubation. Sure, I could probably do those things - I've played around with them, I've watched them used on people, I've tried them on mannequins - but there is no way I'm doing them on a person. Not only am I not educated adequately on them, I'm not licensed to do them, and there are plenty of other things anybody should be doing if somebody is in extremis before thinking about those.

As the National EMS Scope of Practice Model says, (generally speaking):
"an individual may only perform a skill or role for which that person is:
 • educated (has been trained to do the skill or role), AND • certified (has demonstrated competence in the skill or role), AND 
• licensed (has legal authority issued by the State to perform the skill or role), AND 
• credentialed (has been authorized by medical director to perform the skill or role)."
In this case, you may be educated (maybe), and you may be certified (maybe), but you are most likely not licensed or credentialed. Don't do it. Focus on what you can *and* may do.


----------



## StCEMT (Sep 23, 2016)

The redneck in me just says use super glue....but I have also sewn my pants in the parking lot before with a fish hook and 6 lb monofilament line, so I guess in theory you could. But bandaging it sounds easier and less troublesome in practice and legality.


----------



## Underoath87 (Nov 18, 2016)

If its actually your buddy, why not?  So long as he doesn't dime you out to the authorities, nobody is going to lead some huge investigation into how some guy's leg got sutured up in the middle of nowhere.
But I wouldn't volunteer to do it for someone I didn't trust.  The same goes for pretty much any other procedure not covered by Good Sam laws.


----------

