Administration and Leadership, Airway & Respiratory, Cardiac & Resuscitation, Trauma

EMS Can Be Like a Roller Coaster

Issue 6 and Volume 37.

‘Life is truly a ride. We’re all strapped in, and no one can stop it. … I think the most you can hope for at the end of life is that your hair’s messed, you’re out of breath and you didn’t throw up.’ —Jerry Seinfield

I’d bet my minimum-wage income that most of us EMS types would prefer the experience of riding a roller coaster over that of a merry-go-round. I doubt few would argue (and I don’t care if they do) that the prehospital provider’s unique appetite for adrenaline far exceeds that of the average Homo sapien … unless the post-primate in question is an extreme sport enthusiast who, ironically, feeds EMS’ own insatiable hankering for adrenaline by providing them the opportunity to respond to and treat injuries indirectly incurred by the very same high doses of adrenaline extreme sports participants crave themselves.

So, it’s fair to say EMS is addicted to adrenalin—the most potent stimulating hormone of our primal sympathetic nervous system that increases vitality, hyper-vigilance, confidence, stamina and strength; it delays pain response, provides moments of deep euphoria—along with an increased will to survive—during instantaneous moments of intense drama, chaos, danger, unique challenges, mayhem, insanity and lawyers? Naw!

(Sigh.) Like anything that gives you moments of exhilaration, there’s a catch. Apparently, epinephrine and norepinephrine, two components of adrenalin, were meant to only provide 3–5 minutes of good times during bad times. Evidently, a prolonged tachycardia and increased cardiac output leads to high blood pressure, high glucose levels, caused by cortisol (the third component of adrenalin), sleeplessness, gastrointestinal irritability and forgetfulness, which in turn leads to stress, anger, apathy, depression and forgetfulness—and the tendency to repeat oneself.

There are other negative side effects, but I don’t remember them and frankly don’t give a $#@%.

Now I’m not knocking this brief but tantalizing gift of survivalist juice provided by nature. Heck, we even give a manufactured version of the stuff to help those in severe cardiac, respiratory and anaphylactic distress. Indeed, this particular catecholamine has saved my butt many a call when I’ve found myself in danger. Adrenalin gave me the unusual strength to place my resistant partner between me and a combative patient.

On the other hand, try to perform a fine motor skill of EMS, retain pertinent short-term memory of what a patient reports or try to calculate emergent medication doses when your adrenal glands are pumping faster than an epi I-med drip of 10 mg of 1:1,1000 epinephrine in a 250 cc saline bag 60 drops/cc set at a rate of 2 mcg/kg/min, and you can find yourself spazzing out.

Maybe that’s why we consistently train in EMS. Simply put, we train to forget what we’ve learned. We reach a point at which we don’t have to think about what we’re doing to help others. Our treatment becomes an automatic response of composure and skill unworthy of an epi response, which tends to bypass the rational cognitive part of the brain. These are the calls where you and your crew may never even say a word to each other while you treat the patient, because each care provider is already aware of their finely tuned and orchestrated roles. Just make sure you keep talking to the patient because they’ve never heard the music before.

I once read that adventures weren’t meant to have predictable outcomes. Ride the same EMS roller coaster long enough and, sure enough, you’ll be able to predict what’s around every bend. Many have been down the same track for so long that they know the name of the patient and their patient’s chief complaint before they even arrive on scene simply based on the patient’s address. For many disgruntled EMS providers, the epi rush’s trigger then comes not from the adventure, but from the anger and negative perception Mr. Johnson created for the crew who has to put him back into his bed every Thursday when he forgets to take his insulin.

Similar to EMS management, adrenalin doesn’t have a mind of its own. It simply reacts to a perceived threat regardless of its rationality. And like any drug, the body can build a tolerance or even immunity to adrenalin’s effects—requiring an even greater stimulus to get the same previous response despite there never being enough good calls or coffee to feel good about oneself.

Does my heart still skip a beat when tones go off? Like Pavlov’s dog, hell yes (including salivation). But my endorphins now come from a different fix: the laughter of working with a good partner and crew, including a shared laugh with Mr. Johnson.

Ever ride a roller coaster by yourself? Of course not. Share the ride with those who appreciate your humor and you theirs, and then collectively hang on to the bar … unless they’re prone to throwing up on the curves.

Until next time, pass the Zofran. JEMS

This article originally appeared in June 2012 JEMS as “Epi Coasters: Hang on to the bar.”