You arrive on scene and exit your ambulance. As you near the home, you discover you must enter through a window to access your patient. You find your patient faces many complications: an obstructed airway, difficult IV access, poor lighting. You are tense but handle each complication, moving from one difficulty to the next.

Soon you discover your patient now needs pharmacological intervention for hypotension. Medical command advises you to administer dopamine to your 158-lb. patient at a rate of 2 mcg/kg/hour. You freeze. Your face pales and your hands tremble. You take out your pad of paper and numbers begin to appear, but they soon seem to swirl. Sweat now appears on your forehead. Your mind is blank. You can’t remember formulas or even addition and subtraction. You call to your partner to assist you. Time ticks away, and the stress is taking its toll.

It’s not a real call, but it could be. This encounter occurred many times during the 2007 JEMS Games competition at the EMS Today Conference and Exposition. In this instance, a JEMS Games judge, inches away, clutches her clipboard and grips her pen and timer tightly. She’s feeling your pain and longs to tell you to take a deep breath and start over, but game rules prohibit this. Instead, she prays that you have recall and your mind clears.

The JEMS Games feature competitive EMS teams from around the world who are judged on their performance of critical prehospital assessment skills and treatment rendered to simulated patients. Unusual scenarios test teams as they react to and manage a number of patient assessment, treatment and transportation challenges. Scoring is based on skill, speed and technical accuracy, which contributes to the stress of performing in front of your peers.

I served as a judge at the third and fourth annual JEMS Games and was fascinated by the different ways we in EMS approach the same things, and the creativity used by teams to progress through the course. I learned several new skills I can apply to my own practice, but I also witnessed the sheer terror of participants as their minds went blank at the pharmacology station. This concerned me and prompted me to prepare a medication calculation review that was thorough, non-threatening and most of all, easy to recall.

You might be thinking right about now,