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!

As we have been having a few very interesting non-EMS discussions (which haven't ended in name calling), I figured I'd throw out this article I came across on CNN.com

http://money.cnn.com...t=NP1&hpt=hp_t2

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

If I make it over there...you buying dinner?

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:

Heh..yeah, waiting sucked. Waiting while me and likely everyone else knew that I was an idiot for being in that situation? Really, really sucked.

But it was an excellent lesson on intervention planning before implementation.

Dwayne

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.

1. Do you take a PT if they are still recieving CPR? They said something about it but i couldn't hear them.

We only fly the patient in ROSC. There's not enough justification to fly a dead person. We will, however, drive a CPR patient to the local facility to be worked further or for the family. Small community, so that does occur.

2. They said something about pushing for transporting stroke PT's?

We will fly to a designated stroke center if the onset of symptoms are < 8 hours otherwise we will take local or drive.

Of course, the weather isn't always agreeable in Texas and we will drive those same patients because Air won't fly.

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

Pros:

Quite a bit more frank than other EMS forums

More people willing to say, "that's bullshit".

Diverse background, participating has made me a far better provider.

Cons:

Occassionlly there seems to be a fair amount of trolls running around, and a couple of people who use this BB to tell everyone how the world has "wronged" them because of their race/gender/orientation/species/genus/physical attributes/ect

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!!!!

No offense taken here on the halfassery comment:) Beat myself up on this call enough. Usa, you said so yourself you have that luxury of RSI. I on the other hand do not. There was talk on RSI and utilizing it. Here were my thoughts and you can do a double take, I know my limitations. For as much as I would love it in situations like these, unless I can guarantee a spot quarterly in the OR keeping up those skills and that I have a Paramedic partner to assist I will pass. Now with that being said I have heard the largest ground EMS agency may be losing that privilege due to misuse. Which isn't good because I could use them as intercept. You never know what you are missing til its not there anymore.

Dwayne you are my hero:) I am quite close to your location also. I enjoy reading your posts, learn, and agree with you on many scenerios. The patient exhibited cheyne-stokes. Classic Cushings Triad, not sure if I will ever come across it again. Thank you for saying this call sucked.

Here is what happened. Risk of aspiration was already there. Vomit was being expelled through clenched teeth of what may have been beer and pizza for all I knew. I know that versed most likely would not have the effect I wanted on the trismus, but it was worth a shot. Pt was already vomiting when I grabbed it. I was debating nasal intubation, and chose not because of head injury. So I pushed a little versed with no effect obviously. All I could do was roll the board and suction. Pts vitals did not change significantly. I informed them no definitive airway, and that I do not have RSI capability. First thing asked was, "did you administer anything to facilitate intubation". At least I was able to say yes to that.

Dwayne, per my medical director review. He said nasal would have been the choice. He would have backed me on that one. Now it depends on which doc you ask. All have different opinions. Now, if I am ever presented with this again I know which route I am heading. This also lead to a Trauma Review with the receiving facility. I was terrified, but in the end the ER also had their struggles. The physician on review did not agree with nasal and not once was cric mentioned. Versed was just a waste as I held back on giving enough to possibly see any effect. The end thought was to request for intercept of the said agency above.

I was ready to take an ass chewing, but to my surprise I was commended on what we Paramedics face out in rural country without a controled environment or a trauma team at our disposal. This patients prognosis was poor even before I arrived. On a good note, this patient may have saved lives as their organs were donated.

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

I was there...you were not! LOL

Now that Delta has a direct flight from Dubai to Atlanta, it is unlikely I will transit through there again....glad I went the one time I did...it was one of the best times ever in my life. That is sincere...

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

unrequited needs for face to face time with people that sometimes become close as family

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?

I swear my first posts at that, or one of those neonazi sites was to some dickhead that was bashing, (supposedly kindly but with obvious arrogant passive aggression), on some kid that had asked what I thought was a simple, but common question.

I posted something like, "Hey hotshot, how's about you grab your tweezers, put your limp dick back in your pants and cut this kid some slack? Sorry man..Ignore the internet hero...This is what I think....blah, blah, blah."

The very first response that I got to my very first post when I checked back was to see that I'd been banned! And friggin' Dust was a member there at the same time! WTF? Heh....

Yet every month I get a 'We miss you! Come back!" email...Funny shit right there...

And for the record, if this thread derails and ends up just talking shit about stuff? I'm good with that too... :-) I'm just really happy to be able to bullshit with people that speak English...

Dwayne

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

Pros: I keep coming back

Cons: I keep coming back

This site is a good tool to kill a few minutes, learn something new, teach a little, shoot the bull and generally engage the neurons in something collectively constructive.

And I've met a few interesting people here.

But the best thing is you blokes over this side aren't as queer as those neo-Nazi bastards who run that other site

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

I heard a car crash killed Princess Diana. Geez man, at least go with Michael Jackson's physician if you want a good example. Yes, he wasn't on an ambulance, but boy, what a screw up.

I think paramedics trained as RN's are the best providers out there. Your day to day RN on an emergency scene? Ummmm, not so much. I'm not sure what it is about RN training that makes them fall apart on the scene of an emergency but its been my luck that it has happened unilaterally with me. I can give you the horror stories of ACLS instructors and RN sometimes but you probably get the picture. Paramedics: Good in an emergency, bad at just about everything else. RNs: Good at everything else except emergencies.

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

I was merely making the statement of an RN's education is based in long term care and not in emergency medicine. I wrote the statement afterwards because I do know they can specialize.

We are starting to use quite a bot of EBM. Most of the new ACLS, CPR, and PALS changes are EBM. So the argument of a Nurse led EMS team will lead to greater improvements in medicine due to EBM instead of rituals is kind of nil at this point.

Now my wife has a BSN and I am sensitive to others feelings when it comes to RN vs. Medic disagreements so I'm not willing to get into a large debate about all this. Take what I say with a grain of salt.

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

Cons:

An RN's education is geared more toward long term care. I do understand that RN's can specialize. All I am refering to is their base knowledge.

An RN's skill base isn't as large as a paramedics when it comes to life saving procedures. Again I understand they can specialize and broaden their scope.

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!

Heh...my last gig was on a Dutch drilling vessel, the Maersk Developer. Part of my job was to enter the comings and goings of personnel into a maritime program in Dutch....Good God!!!

Aside from your horrid taxes, and you're not understanding that there is never, ever a reason to put 6 vowels in a row in any given word, I could find nothing not to love about the people, or the company. Very kind, people before pennies (my saying, as well as my impression, which could of course be wrong, having only been with them three months.), hard workers. I felt welcome from the moment I stepped on board and I was sad to leave.

But deep down, I'm American through and through. I'd get claustrophobic in a country that you can ride a bicycle across...

But I'm grateful for the offer brother. And it holds here as well should you decide to come this way...

Dwayne

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.

I hate your system WM...It's stupid, and can't possibly work...

(Do you hire American Immigrants??)

Dwayne

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

As someone who`s bearded, I just wanna point out, that there is no direct connection between facial hair and a lack of professionalism...

But Mike, I hear you, I`ve been in this kind of position, too - there`s not much you can do about it, though.

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

Man...see, this is what I love about you guys. While you state that many have no concept of ever needing to transport two patients in one ambulance, I truly had no idea that there were places where that wasn't a common reality...having never worked big cities...Pretty cool...

Welsh and Bushy, what about two patients, one cot? (No, that's not a gross out video.)

And, of course, I did take them both. But I did choose to take them both on one cot only because I really had no idea what was truly going on with either so was afraid to let either one be out of my view for long. So I put the boy, who was strapped to the L/B on the cot, the sister who was secured in a KED with their legs next to each other, strapped the hell out of them and away we went.

As it turned out we got a hole in the weather, Flight for life notified us that they believed that they could get much closer if we wanted them to. I really wanted them to. They landed about 15 minutes away, took the kids in my original configuration and away they went.

Of course, different decisions may have been made had my crystal ball been functioning properly, but I doubt it. But I'll never forget FFL choosing to stay on top of the call and notify me when they felt that they could punch through a hole in the weather instead of just sitting at the warm hospital drinking coffee. It would have all paid the same for them...

I love remote medicine for the challenges of being 'stuck' with really sick and/or injured people, but long transport multisystem/head injury trauma can kind of freak me out. Not literally, but enough that it takes the fun out of it. There is just so much going on, much of it you have to be theoretically aware of all the time if you're going to catch the physiological markers quickly...I'm not so good at that often. In this case, I just wanted smarter people to take these kids off of my hands...

But one thing was for sure, neither of them was staying home, and neither of them was going to sit still waiting for add'l help...

Thanks all.

Dwayne

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

Interesting how many people have missed the point that providing adequate pain management is about providing humane management. To not provide through lack of equipment, skill set or protocol is inhumane at best and negligent at worst

Pain is pain

Just sayin

As for the K-juice, we trialled it here and it was an astounding drug. The stand out demo for me was a patient partialy ejected in a car v's tree, ended up with her mangled legs mashed in amongst the front drivers side suspension / sterring arms screaming her head off

Special K sorted her out real good.

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