Paramedic Care Series – A Decent Paramedic Textbook

Well, I guess there’s only one worth getting.

I hate paramedic textbooks. They’re all pretty much terrible, but each one is terrible in its own, individual way. The fact is that no textbook can ever be perfect – medicine moves fast, and paramedicine is finally dragging itself out of decades of protocols into the realm of evidence based practice. And yet our textbooks haven’t kept pace. If I want to know best practice I have to use the Internet to find it – because it sure as hell won’t be in a book printed two years ago. And that’s fine – some fundamentals don’t really change after all, and the very bleeding edge of medicine often isn’t something we can safely practice (usually due to liability).

In Australia, the situation is particularly bad. We rely on textbooks from the US or the UK, and the UK textbooks are typically based on US versions. The problem with this is that the US books were written to pass standard exams, and the UK books also reference national standards that we don’t have. In Australia, you go to university and end up learning general paramedic care, plus a set of state-specific protocols. In one state you’re expected to interpret 12 lead ECGs. Cross the border and all you need to do is recognise a shockable rhythm. Cross another border and the basic skill set skyrockets into critical care territory.

So what good are paramedic textbooks? If you really want to learn pathophysiology, you should read a book on pathophysiology. If you really want to learn critical care, you’re going to need an actual medical textbook – one written for interns or registrars, because your standard of care is expected to approach that level (except you don’t have half the toys to help with diagnostics). Some people even read nursing textbooks – such is the poor quality of many paramedic texts. There’s one thing none of these books can teach you – prehospital care.

What a good book does

My definition of a good paramedic textbook is one that does the following:

  1. Teaches you paramedic, prehospital patient assessment
  2. Teaches you airway, ventilation, and perfusion maintenance
  3. Teaches you good prehospital trauma care
  4. Explains hypoperfusion holistically and to a good depth, linking it to clinical presentation
  5. Covers a few important prehospital chief complaints and some of their most common causes and management

Paramedic textbooks try to do too much – and they end up being an absurd number of pages long without saying anything at all. They also end up being inconsistent with their application of knowledge. They need to be focused on prehospital care to be of any use.

The basics of paramedicine is ultimately managing ABCs first and foremost, and with that comes an understanding of perfusion. But perfusion needs to be treated as more than simply the movement of blood, but also what’s in that blood (oxygen, CO2, glucose, etc). Once a person understands their ABCs really well, they can build on that to understand most other things. We also have unique approaches to patient assessment and trauma. We lack a lot of diagnostic tools that hospitals have, and our level of clinical assessment is higher than most RNs (in Australia at least). Our trauma care is often critical, particularly in major trauma, and sets the scene for the hospital. That’s what we need to focus on with paramedic textbooks – how to do these important tasks.

The medical sector is where things become a lot more murky – because there’s a lot of things to cover, assessment becomes more complex, and the pathophysiology can go on for pages and pages if you want it to. And yet so much of the management is ultimately going to be the same – supportive care, your basic ABCs, pain and nausea relief. The number of cases where we have specialist interventions that really matter aren’t particularly long. Things like acute coronary syndromes, seizures, cerebrovascular attacks, diabetic emergencies, the various significant respiratory pathologies (like asthma and COPD, croup, etc)… those are the things that need to be covered. Covering every little complaint in great depth is best left to a pathophysiology book and a medical textbook.

To that end, I think we need a book that focuses on symptomatology more than anything else – things that we actually assess, like chest pain, shortness of breath, altered level of consciousness. Students need help with their assessment to get from “Here’s a chief complaint and a bunch of physical assessment data” to “It’s probably a pulmonary embolism”. And yet very few books actually do that, and those that do are usually case books that ultimately need lots of companion material to help you.

Paramedic Care: Principles and Practice

There’s an impressive series of textbooks (separated out into volumes) by Bledsoe et. al. which I think is probably the best of the textbooks out there. It’s called Paramedic Care: Principles and Practice and it’s separated out into about 8 different volumes, each focusing on a particular aspect of paramedic care. There’s an International version available (but it’s still US specific, so I don’t know what the difference is) and it’s also available on Amazon’s Kindle library, so you can just purchase whatever volumes are relevant.

Previously I looked at Essentials of Paramedic Care (again, the International edition) which is a combined and condensed version of these volumes. I said that it was actually not a bad textbook, but it was laughably out of date and poorly set out (in fact, it’s based on 1998 standards with a few newer elements tossed in). This volume set is actually fairly up to date, with the exception that it still advocates limiting pain relief with abdominal pain.

So what makes this a good set of textbooks for paramedic students? Firstly, the fact that volumes are split means that each one focuses itself quite well on its chosen topics, and they’re easier and quicker to access. The layout of the text is well presented and broken up with plenty of images, avoiding the “Too Long; Didn’t Read” problem with lots of other texts. There’s a surprising amount of detail in some sections, and it covers off well on the fundamental ABCs of paramedicine that so many other textbooks end up getting wrong. Most importantly, it’s a fairly cohesive book that tries to stick to what it’s taught you in previous chapters. Lots of books will say to you “Here’s a system for assessment” and then promptly change it entirely in subsequent chapters.

Some conditions are treated with the right level of depth – like acute coronary syndromes – that represent how important they are to paramedic practice. To its discredit though it does waste a lot of pages on bits and pieces that barely rate a mention – and its information is shallow and largely irrelevant, things that would be better covered by a pathophysiology textbook. Unfortunately, it’s based on generic headings like “Cardiology” or “Gastroenterology” rather than organised by symptoms.

That said, the fact that it’s quite cohesive and well written, as well as being quite comprehensive with a strong foundation in the basic ABCs of care means that I’d probably recommend this series to paramedic students. I wouldn’t buy the whole volume unless your specific class needs it – the volumes on the absolute basics and operations probably aren’t that useful, but the rest of them certainly are.

Does this tell you everything? Nope. Far from it. But this teaches you the fundamentals of how to do your job – how to go to a patient, assess them and safely treat and transport them with a working knowledge of a lot of conditions you’ll face. It’s a good basic understanding for paramedics. To take it further you’d need a pathophysiology book, and you’d need a medical textbook for additional treatment, but this is a good foundation.

It also covers ECGs to a reasonable depth – a good working knowledge of ECGs that would let you cover most rhythms and important diagnostic features (like STEMIs or BBBs) to be a good paramedic. Far from a full ECG book, but generally adequate for most paramedics.

Soldant’s Holy Trinity

I guess if I had to recommend only three “books” (if we count volumes as one book) I’d go with these:

  • Paramedic Care: Volumes 2-6 (Bledisloe et. al., Brady/Pearson). This would cover off on the fundamentals of paramedicine, and covers off on all of your basic ABC management, patient assessment, and trauma/medical/special populations conditions and treatments. I wouldn’t bother with the other volumes unless you have a special interest. At the time of writing, you can pick these up on the Kindle AU store for about $130.
  • Understanding Pathophysiology (Huether, McCance – Mosby). This book got me though nursing school and paramedic school. It covers off a functional knowledge of anatomy and physiology, and then delves into pathophysiology to a good degree. Using this to learn about conditions (especially those covered in your paramedic textbook) will greatly enhance your understanding of how the body works and how it breaks, and why your treatments actually work. It’s big, it’s thick, it’s sounding a lot like a euphemism, but it’s one of the best.
  • Textbook of Adult Emergency Medicine (Cameron et. al). I recommend this especially for Australians. Written predominately for medical interns operating in the ED, it’s accessible enough to be of great value to paramedics. It’s a no-nonsense, practical guide that doesn’t waste time explaining basic concepts. If you don’t know your anatomy and physiology, you’ll struggle. If you do though, you’ll find it says an awful lot without a load of words. If you want to take your care to the next level, this is the book to read. Only covers adults – there is a matching paediatric one too, though I haven’t read it.

If you get these three books, you’ll do well. The Paramedic Care volumes will feed you the fundamentals and practical aspects of prehospital care. Understanding Pathophysiology will give you the underlying knowledge to understand how things break and why your treatments work (or won’t work). The Textbook of Adult Emergency Medicine will show you how the ED doctors do it – and thus how you can become a better emergency are provider.

Recommended Texts

  • Principles of Anatomy and Physiology (Tortora & Derrickson). This book was my other best friend during nursing school and taught me anatomy and physiology. It goes into an incredible amount of depth and will teach you anything you want to know about A&P. While Understanding Pathophysiology above gives you some A&P, this goes into way more depth and may make it easier to understand how the body works. It’s not too inaccessible either.
  • Paramedic Principles and Practice (Johnson et. al.). This is a casebook focused on Australian/NZ paramedics that looks at a number of common callouts and walks you though assessment and treatment of a number of patients. Each condition typically has two or three cases – one case will be the typical callout while the others will often have atypical presentations or present a diagnostic challenge. It isn’t comprehensive but it is a very good book to help with clinical decision-making if you’ve got the money to get it.
  • Tintinalli’s Emergency Medicine. This is another very popular medical intern book and it’s probably a bit more comprehensive than Cameron’s book above – but with that comes a lot more words which sometimes isn’t overly relevant. It’s also very US-centric, but it covers a lot of conditions in quite a bit of depth. Maybe worth considering but not really my first pick.
  • Some sort of ECG book. People seem to have differing opinions on what a good ECG book is, so I don’t really have any specific recommendations. For a good basic understanding, the Paramedic Care books above do just fine. But if you want to really learn ECGs, you’ll need a dedicated textbook. Maybe ask your mentors/colleagues what they found helpful.
  • Advanced Paediatric Life Support (ALS Group). This book isn’t overly expensive and is actually very well written and highly focused. Written for both hospital and prehospital staff, this text is quite accessible yet also goes into quite a bit of depth. It focuses entirely on paediatric concepts and thus may be highly useful to help you assess children. You might get on well enough with the above books though, so I’d only get it if you have a particular need for it.
  • Prehospital Emergency Obstetric Training (ALS Group). Written specifically for paramedics, this book covers off on a load of obstetric problems. I hesitate to recommend it too strongly because it’s written a little strangely and doesn’t flow very well, and some of the procedures are a little out of date, but it does offer some good guidance to a particularly scary part of emergency care. Consider it if you’re worried about obstetrics.

 

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