# New Paramedic Scope.



## EMTFozzy (Feb 5, 2013)

I was wondering the changes that was brought with the transition and the 2013 scope. I keep hearing things on what was changes like suturing and stuff to do with chest tubes. I was wondering if someone could clarify what the changes are.


----------



## VFlutter (Feb 5, 2013)

I hope not. 

I see no legitimate reason to add those skills outside of flight and CCT.


----------



## usalsfyre (Feb 5, 2013)

Chase said:


> I hope not.
> 
> I see no legitimate reason to add those skills outside of flight and CCT.



Chest tube management (not insertion) is not exactly difficult and to my knowledge is the "skill" that is discussed in the new curriculum. 

Suturing for whatever reason has been a "dream" skill of paramedics all over for years. While there have been times I've wished I could throw a stitch in something to secure it better it's not something that is particularly needed in normal ground or flight EMS. Very useful in remote setting however.


----------



## EMT B (Feb 5, 2013)

my dad (90s medic) said that if medics are given suturing, chances are that any stitches they place will be taken out so that the hospital can look at the cut again anyway..


----------



## chaz90 (Feb 5, 2013)

I could only imagine suturing having any place in the pre-hospital setting as an extension of community paramedicine. Advanced/Extended Practice Paramedics in a community medic role seeing a minor lac on an extremity and throwing in a few simple loops to close it up rather than send the pt. to an ED definitely has it's place. I envision this as a very limited role and skill set that the average street medic would have zero use for. I do like simple chest tube management being added, as IFT medics routinely see these kinds of transfers. The other changes with 12 lead EKG and CPAP are just long delayed.


----------



## medicaustik (Feb 6, 2013)

I think in the coming years you're going to see paramedics doing more wound care, suturing, etc and an opening in the medicine sector for paramedics visitng patient homes (non-emergency). 

I think there are a couple of jurisdictions out there who have a paramedic who makes house calls for minor stuff, and it helped reduce their run numbers.


----------



## Rykielz (Feb 6, 2013)

In California specifically, I doubt we'll see anything added outside of new medications or devices. The medical directors are too afraid of liability.


----------



## Wheel (Feb 6, 2013)

Rykielz said:


> In California specifically, I doubt we'll see anything added outside of new medications or devices. The medical directors are too afraid of liability.



As they probably should be as long as the "education" is so short, often coming from providers with no formal education themselves.


----------



## ExpatMedic0 (Feb 6, 2013)

I have taken it 6 weeks ago. Please see my post regarding the changes here. http://www.emtlife.com/showthread.php?t=33273&highlight=bridge


----------



## mycrofft (Feb 6, 2013)

Prehospital suturing of wounds (not referring to securing chest tubes here) has to be taught with prehospital debridement. That means some plastic surgery concepts as well, especially if you are working on hands, articular areas (anecubitae, joints generally) and of course the face. DO you really want to be giving local anesthetics and maybe some benzos so you can be slicing away tissue in the field before laying in some stitches to make things look neat?*

I don't even like to see Steristrips in layperson kits, nor butterflies, but with training they can be safely used for clean incision-type lacs away from hair and without foreign material contamination...mostly.

Korea is where they pretty well stopped suturing wounds before the hospital due to the necessity for extensive debridement due to infections, amputations, and funerals.


*We are hardwired, along with our simian relatives, to neaten up wounds, cover them up. If you shoot a monkey with a blowgun it will run away through the forest and you will have missed supper. If you put a bit of red cloth on the tail of the dart, the money will sit there and try to push it back into itself until the curare fells it, and you have your meal.


----------



## wildrivermedic (Feb 9, 2013)

Yes, people do seem to have a fetish for suturing. Every wilderness first aid class that I have taught, someone has asked about it. Sometimes quite insistently and with growing disapointment. 

Not a useful skill for us without a) the ability to prescribe antibiotics for the certain infection and/or b) no access to the hospital, like ever. More than 3 days at least. I've been told it's an expanded skill in Alaska where both those conditions are met.


----------



## medicsb (Feb 10, 2013)

Chase said:


> I hope not.
> 
> I see no legitimate reason to add those skills outside of flight and CCT.



I see no reason to even add those skills to flight and/or CCT.  

as for suturing mentioned previously...

I can only imagine the problems (and disasters) that could be associated with paramedic suturing.  It could probably be done if limited to a very small number of medics who are willing to spend a few hundred hours in hospital just to become proficient.  Good luck finding a non-academic hospital that would let you suture.  At the academic ones, you will have to compete with medical students, PA students, NP students, and intern physicians.


----------



## usalsfyre (Feb 10, 2013)

medicsb said:


> I see no reason to even add those skills to flight and/or CCT.



I see you haven't spent much time around FM staffed EDs....


----------



## shfd739 (Feb 10, 2013)

usalsfyre said:


> I see you haven't spent much time around FM staffed EDs....



My thought too. And some EM staffed BFE EDs.


----------



## VFlutter (Feb 10, 2013)

shfd739 said:


> My thought too. And some EM staffed BFE EDs.



If an EM Physician can not place a chest tube then there is a serious problem.


----------



## shfd739 (Feb 10, 2013)

Chase said:


> If an EM Physician can not place a chest tube then there is a serious problem.



Maybe.

When they are in a low volume, majority low acuity, small/middle of nowhere town and suddenly have a critical patient show up POV or for stabilization by local EMS it happens. 

Real easy to get flustered when there are only a few hands trying to play catch up on an ill patient type they may see a few times a year at most (if they happen to be working that day).


----------



## Carlos Danger (Feb 10, 2013)

Chase said:


> If an EM Physician can not place a chest tube then there is a serious problem.



Don't worry though, even if the EM physician can't do it, the paramedic can 



shfd739 said:


> Maybe.
> When they are in a low volume, majority low acuity, small/middle of nowhere town and suddenly have a critical patient show up POV or for stabilization by local EMS it happens.



Have you ever seen a case where a physician was unable to place a chest tube, and a paramedic was?


----------



## shfd739 (Feb 10, 2013)

old school said:


> Don't worry though, even if the EM physician can't do it, the paramedic can
> 
> 
> 
> Have you ever seen a case where a physician was unable to place a chest tube, and a paramedic was?



Nope. I have seen medics switch a glass style drainage system over to a thoraxclex. There are some ERs still using those in rural areas. 
Never said a medic placed a chest tube.


----------



## MSDeltaFlt (Feb 10, 2013)

EMTFozzy said:


> I was wondering the changes that was brought with the transition and the 2013 scope. I keep hearing things on what was changes like suturing and stuff to do with chest tubes. I was wondering if someone could clarify what the changes are.





usalsfyre said:


> Chest tube management (not insertion) is not exactly difficult and to my knowledge is the "skill" that is discussed in the new curriculum.
> 
> Suturing for whatever reason has been a "dream" skill of paramedics all over for years. While there have been times I've wished I could throw a stitch in something to secure it better it's not something that is particularly needed in normal ground or flight EMS. Very useful in remote setting however.



Yes, chest tube management is one of the things being taught in the transition to NRP.  And to be perfectly honest managing a chest is so far from rocket science that it isn't even funny.  It should've been taught years ago.


----------



## VFlutter (Feb 10, 2013)

MSDeltaFlt said:


> Yes, chest tube management is one of the things being taught in the transition to NRP.  And to be perfectly honest managing a chest is so far from rocket science that it isn't even funny.  It should've been taught years ago.



Ah ok, I thought they meant chest tube insertion not chest tube management. Ya managing a water sealed chest tube is pretty straight forward.


----------



## medicsb (Feb 11, 2013)

usalsfyre said:


> I see you haven't spent much time around FM staffed EDs....



Your point is?


----------



## Smellypaddler (Feb 15, 2013)

Don't worry the world hasn't ended yet but there are paramedics in my neck of the woods that suture wounds and prescribe anti-biotics.

Given the appropriate level of training anything is possible and their role is to remove pressure from the already overstretched emergency room.  Why remove a doctor from the ED floor to suture basic lacs when it can all be done at home?

Extended care paramedics (ECP's) take on a role similar to a nurse practitioner and are able to keep a lot of sick patients out of the ED.  In turn freeing up resources and allowing patients to stay at home.

As for increasing the scope of ALL paramedics to cover these things, that is another matter.


----------

