WelshMedic

Portland Medic, Let me tell you the good news: you have already taken a very big step to you recovery by seeing the problem. Let me explain: I have been in the same position as you. My "battle stress" almost cost me my marriage, my children and my health. I, too, became very fond of the bottle; had eating binges and was generally a a$$hole to all of those around me that I love and cherish. Mine was also caused by the traumatic death of a colleague followed by 3 child deaths in 3 weeks. I won't dwell on that though, this is your story, not mine. I finally came to see that I was losing it all. I went to my employer and took sick leave. The next thing I did was go to my doctor, who put me on anti-depressants. All I can say is that although they are great for some, it didn't suit me. I didn't like all the emotions of depression but the pills gave me no emotions at all. My saviour was a psychologist who was specialized in PTSD from the Dutch Military. She really opened my eyes to me behaviour and why I was doing the things I did. Recognition is the first step, that the only way to do it properly. You have the added complication of an addiction to cocaine (or I assume, at least. Please correct me if I 'm wrong). The thing is, you need to tackle that as a priority. For the simple reason that the addiction is a barrier to solving all the psychological issues you have. Please, for the sake of your own health and of your loved ones, seek professional help. We can and will help you all we can with this here but we are no subsitute to professional help. Take care and don't hesitate to contact me if you feel I can help or add anything here. WM

The link doesn't work, mate!

There are a number of topics that are strictly US related and, therefore, I dont feel qualified to comment. The Occupy movement is not one of those as it's fast becoming a global phenomenon. My take on the subject: In essence, the Occupy movement is a great initiative. However, it's just that. We are not going to change or better the world by sitting in tents. We will do it by getting up off our a$$es and doing something about it. I think the guy in the article makes a good point, your life is your own responsibility. That's not to say that the banks didn't take huge risks in the past, putting people's welfare in jeopardy. However, those same people took out, amongst other things, those sub-prime mortgages themselves. I the knowledge that if just one thing went wrong, then they would have to default. They signed to that effect, they should have thought about the consequences before putting pen to paper. My mortgage is half the market value of my property. I would hate to have to do it, but even in this deep financial crisis, selling my house would not land me in debt. Oh, by the way, my mortgage is the only form of debt I have. Of course there are heart-wrenching examples of poverty and suffering by hard-working people, and that is very very sad. But they accumulated debt themselves, and now they are suffering the consequences. It's about time we realized that the consumer orientated, materialisitic, credit card society we live in is broken. If you can't pay for it, you can't have it. Coming back to the Occupy movement, the statement has been made. It's now time to get the economy going again and not dwell on past mistakes. WM

I got you covered. You choose or I'm a classy guy you know!!!!! Seriously, you are more than welcome, I may even stretch to this:

That sucky feeling changed something in you and you changed your practice. That's why these things happen, so that we can learn from them.

Wow, 8 hrs!!!! It's <4 hours here.

I wouldn't have thought so, most choppers are physically too small to do so. Re: Stroke patients. Any form of acute neurological event needs to be investigated. The problem is that you are never entirely sure what's going on until a CT scan is made. It can either be a hemorrhagic or an ischaemic CVA. As long as the ischaemic CVA doesn't have any contra-indications (onset time being very very important) they can sometimes be thrombolyzed. The other side of the coin is that giving thrombolytics to a hemorrhagic CVA would be a disaster. So, the trick is to get your pt. to a dedicated stroke center on time. I can imagine that in some rural areas the chopper may offer a pt. more chance by reducing transport times. WM

I would just like to point out that I am a fat, over 40 foreigner that also happens to be a male nurse. I have had a very hardlife, you know!!!!

Krysteen, I think it's brave of you to put this out here. It is a classic situation where you have your back to the wall. I don't do RSI either, so I would have been facing the same problems. I have been in similar situations in the past but have usually been able to manage the airway to an acceptable degree with a BVM. I have never done nasal intubation (it's not taught here) but it's an interesting option. MY only other option would be to cric the pt. TO be honest, you know it's a last ditch thing but who really does have the guts to cut open someone's neck? I never have, in any case. WM

Well, when Delta goes into the stratosphere with their prices and you are forced to do a stopover, please consider me as an option...

I know what you are talking about. It saddens me sometimes to think that, due to the physical distance, I am never really likely to meet any of my "family" WM PS - anyone fancy a vacation in Amsterdam?

Oh, now I know what you lot are talking about! That's the other thing I've noticed lately, more of us are willing to put our balls onto the line in order to learn from a scenario. I think it's great that people feel comfortable enough to do that here. The logical conclusion to all of this is that we can look forward to some excellent case scenario's in the near future. I know you'll think I'm over the top ( well, he would anyway..) but I can see a certain person looking down upon us and smiling. WM

Uh? Am I missing something? Where is that?

Damn, you seriously do have too much time on your hands! I see the City as a resource. There are a great deal of knowledgeable people here and I have learned great things from them. A lot of the stuff I read here I then research myself which leads to a better understanding and a greater knowledge. As in every community, there are also the village idiots. This is a public forum and so anyone can join. I personally don't have a problem with most, but it is annoying to be in a great topic of conversation and have somebody steamroll through it with their ignorance. I sometimes think that there should be a little more Moderation at the City. All in all, I think the pro's far outweigh the cons and I hope to be visiting here for a long time to come. WM

That's Dutch EMS FUNBAR'd then,,,

Don't worry, I wasn't put out by your statement, just putting my 2 cents worth into the discussion. I happen to have a great deal of respect for my paramedic colleagues, both here and in the real world. I just don't subscribe to the idea that nurses can't make the transfer into EMS. We can and do with a great of success. But to be fair to you, you didn't actually present that as a statement of fact. The truth is that whilst I do defend my position here, in the real world (here in the Netherlands) I may be one of a dying breed. It's becoming increasingly difficult to find suitably qualified RN's. Which is why the first degree in EMS has started here this year. We seem to be slowly making the transition into the Anglo-Saxon model of EMS delivery. WM

Why did you make these statements and then directly contradict yourself? An RN's education isn't specifically geared to long-term care. It is, however, a broader knowledge base that utilizes a holisitic approach. That base equips us to assess, treat and release patients, making nurse-led EMS efficient when looking at health care at macro level. The thing is, I don't actually believe it makes a great deal of difference in "life saving" measures. ACLS and PHTLS are the same principles, regardless of who is carrying them out. I may even beg to argue that, if nurse led, there may be more research which would lead to EBM instead of rituals. WM

It was a joke ( a bad one, it seems). I didn't mean you, obviously!

Dwayne, Gosh, I always thought Maersk was a Danish company! Even I can learn a thing or two, it seems,haha! You're right the tax thing is horrendous. It went up to 52% income tax at the beginning of the month. But the bike thing can be quite handy.. I was in Delaware a few weeks ago and had the idea to rent a bike to cycle to Philly (you must be getting visions of a bloody stupid European by now..). I got as far as the state line and then turned back. I had a near miss with a 24 wheeler at least 3 times in the intervening periode. I had visions of going home in a box..... Oh, when you are at home, I may just take you up on that offer.. I hear Colorado is a swell place and I've always wanted to go rafting! Carl.

You get yourself off to Dutch conversation classes and I'll do the rest....

Bernhard, I agree entirely. As long as it's neatly trimmed and doesn't contain last night's dinner to be consumed as a snack today...

Hi all, Here in the Netherlands EMS is nurse led. IFT trucks have RN's and ALS trucks are CCRN's (we have no BLS tier here. Front-line, it's all ALS). I do happen to think that nurses have something to bring to the table. It starts at dispatch, there the triage nurses take the calls and advise appropriately. That means that an ambulance response is not automatic, a percentage is triaged back to the GP.Due to the broader training and education we are also far happier to treat and release patients ourselves (or refer them to the primary healthcare practioner) which makes financial and clinical sense. It does not burden the system with unnecessary transport and our colleagues within the hospital are then freed up to do what they are trained for, look after bick sick people. For anyone interested, one of the UK journals did a special on EMS in Holland. You can find it here: www.ambulancetoday.co.uk WM

Dwayne, You get my vote as that is exactly what I meant by topping and tailing the kids on one cot/backboard. I can't see any other workable option that would benefit both these kids in your scenario. Uder Dutch law, we are not allowed to convey more than one pt. anyway but I will sometimes make an exception for someone with an extremity injury. That's the joy of the job, adapting to each individual case. WM

I would have the same problem as Bushy as I only have one stretcher and no other options. If my back were to the wall (but it's not likely, Holland is so small that there's always a second truck within 15 mins away) then I may consider transporting both children on one backboard by top and taling them. No, it would not be ideal, but the alternative would,effectively, to let one of the kids die. However, this is all very theoretical to me. I sincerely hope I never have to face the said situation. WM

Yep, it does that to a person. You take one panicked individual and turn them into a calm, serene, easy to work with person. You trialled it? Do you still have it then? I'd hate to think of it being taken away. WM