Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Comment on Are We Killing People With ROSC?


In the comments to Are We Killing People With ROSC? Adam Thompson, EMT-P of Paramedicine 101 writes –

Go figure, right? I suppose that’s where the old H’s & T’s come in…


The Hs and Ts do not really affect the dose of epinephrine.

I have never liked the Hs and Ts mnemonic. I know what you’re thinking: ‘Did he recall six Hs, or only five?’ Well, to tell you the truth, in all this excitement I kind of lost track myself. But, being as this is epinephrine, the most powerful cardiotoxin in the world, and would blow your head clean off, you’ve got to ask yourself one question: ‘Do I feel lucky?’ Well, do ya, PUNK?

Since PUNK is the patient, PUNK is not likely to respond. PUNK is dead.

There are arguments that other drugs are more powerful cardiotoxins, but they are not routinely used for resuscitation.


I have always thought it was crazy that if someone has a ‘heart attack’ we fill their static vasculature with epinephrine, so when they get a pulse back, they now have a chemical pumping through their blood that is known to be lethal in people with acute coronary syndrome.


The blood should not be static if there are effective chest compressions. Nobody should be considering any drugs in the absence of chest compressions for a cardiac arrest patient.

Also, if it constricts the blood vessels of the entire body, wouldn’t that include the cerebral arteries…making cerebral anoxia worse…? “But hey, if we get pulses back, who cares?”, says the cretin medic.


Epinephrine has both alpha and beta effects, so there is probably a combination of constriction and dilation of the arteries.

It does not appear that epinephrine produces the beneficial effects that the physiologists claim that epinephrine produces, based on their knowledge of physiology. At least, no beneficial effects other than the supposed beneficial effect of ROSC (Return Of Spontaneous Circulation), which seems to be harmful for those who receive epinephrine. For physiologists, maybe understanding of the word beneficial is inconceivable.

Any physiologic claim that cannot be backed up by improved outcomes is just an example of the arrogance of ignorance.

Half a century of hundreds of thousands of patients treated each year, but still no evidence of benefit.

What? Increased ROSC is a benefit?

It allows the family to say good-bye to their comatose family member for a price that is profligate.

It allows the EMS crew to claim they had a save!

It allows us to pretend that a pulse and a life are the same thing.

Image credit.

If we do not understand the difference between ROSC and a living, thinking person, then ROSC is a reasonable goal.

ROSC is not a reasonable goal.



  1. The “Hs and Ts” is like any mnemonic, a useful reminder as long as it’s not taken to the level of dogma. You and Adam hit it right the first time: we need to stop thinking that all cardiac arrests can be treated the same way. He’ll, we don’t defibrillate everyone; why should we think that Epi works in all cases?