Paramedic Textbooks for Australian Students

Rewritten for July 2017!

Previously I’ve written posts on paramedic textbooks for Australian students. It’s gotten a bit long and it’s a bit too challenging to keep editing. So I’ve re-written it to be a lot shorter. And now that it’s July 2017 and I’ve read pretty much all of them out there, I’ve come up with what I think is the best solution for Australian students looking to educate themselves.

The Problem for Australian Students

In the US, you go to EMT-Basic school, get an EMT-B textbook, and learn from that. Then you can go on to EMT-Paramedic school, get an EMT-P textbook, and that’s the end of it. In Australia… there is no EMT-B. There’s no EMT-P. You (almost in every case) go off to do a Bachelor Degree in Paramedic Science (or similar) use a combination of textbooks, and get thrust into a scope that’s between EMT-I and EMT-P, but with the knowledge and clinical decision-making capacity above the average EMT-P.

This creates a gap. What we gain in high level knowledge, we miss out on in fundamental prehospital skills. Any idiot in the degree can figure out how to clumsily shove in an OP airway and use a bag valve mask, but few of them can really identify when to choose an OP over an NP, or the true indications of when to bag a patient or not (they know what tidal volume is, but have no idea about minute volume, nor what constitutes true respiratory failure). This is actually made worse by universities trying to crowd out prehospital care textbooks in favour of medical textbooks – textbooks written for professions that don’t have to deal with limited equipment, limited information, and uncontrolled environments.

As a result, I still believe there’s a very strong need for an independent textbook list – one with a paramedic textbook at its heart, a textbook that’s easy to read, simple to understand, and remembers the basics. Thus, I present my list.

 

Essentials

These are the books that, in a perfect world, every student would have access to. These are the books that I found to be the most helpful during my studies and internship, and in some cases even into qualified practice. Reading them would help an Australian student significantly, in my opinion.

Nancy Caroline’s Emergency Care in the Streets (Price varies): This venerable tome is probably the ‘best of the worst’ for Australian students. It has a lot of problems – it’s the most simplified of all the paramedic books, it lacks a bit of detailed anatomy and physiology, and it has a few holdouts from the 1980s teaching style from Dr Caroline herself (Sidney Sinus, anyone?). But for all its faults, it’s the easiest book by far to grasp – and if you’re an Australian student who has zero prehospital knowledge, it’ll bring you up to speed. The weaknesses are easily augmented by your degree program – but the simple approach of the book will fill in the stuff that the degree glosses over. Read it cover to cover (well, almost – some stuff is irrelevant waffle). The new 8th Edition is due in September 2017, but the 7th Ed isn’t bad (the 6th is a little too old now, unless you’re willing to deal with some inconsistencies). Unfortunately, it’s expensive (really, really expensive) and there’s no eBook available. Buy it second hand wherever possible, but beware that it’s mostly US sellers that will sell it. You can also try the Amazon US site too – sometimes editions appear cheaply there too. Beware that it’s sometimes sold as two separate volumes – Foundations/Medical and Trauma/Special Cases. Honestly, for all its flaws and expense, it’s still an excellent book. I wish I’d had it during my degree.

Textbook of Adult Emergency Medicine ($76 AUD): For all of the gaps in Caroline’s tome – this is your gap filler. Easier to read and more applicable to Australian practice than the other emergency medical books, Cameron et. al.’s textbook is a pretty good one. It isn’t quite as comprehensive as some other texts, but it’s very much to the point and filled with practical advice. Sometimes it’s hard to apply to the prehospital environment, and there are some instances where its advice doesn’t translate, but by and large it’s a great help with diagnostics and management for a wide range of conditions. It also covers a few other topics like arterial blood gases. Many universities now recommend this text, probably because it’s so easy to read and quite concise – which I absolutely love about it. Note: There’s a paediatric version too, but whether or not you’ll find it useful will depend on your needs – I haven’t used it too much because paediatric prehospital care is limited and extremely cautious in its approach, so a lot of it isn’t overly relevant to my practice.

The ECG Made Easy ($23AUD). Or: Rapid Interpretation of EKGs (Varies)Either one of these books make for a good ECG book. Dale Dubin’s Rapid Interpretation of EKGs has been around since forever, and is an extremely popular book because it’s dead simple to understand. Dubin himself is a creep, but he could teach cardiology like nobody else. Alternatively, The ECG Made Easy is sort of like a modern Dubin – focused on reading ECGs rather than electrophysiology. Either book is a good choice to help with reading most 12 leads you’ll see (it won’t teach you Sgarbossa criteria, but once you’re at that level, YouTube is better at it anyway). Dubin’s book can also be found in PDF form online with very little effort, and given that it’s out of print and Dubin is a criminal, I doubt anybody will lose sleep if you… ahem, liberate it.

Resources to Consider

Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. $176 AUD. Tintinalli is a titan of emergency books, and it’s a bloody good one too. It covers pretty much everything, with lots of images, photos, and diagrams along the way. It’s not as easy to read as the above books, nor is it quite as concise (in fact, it’s pretty wordy in some areas), but it will tell you pretty much everything you need to know about emergency medicine. That said, a significant portion of it has almost zero relevance to prehospital care – because a lot of the diagnostic approaches rely on technology we simply don’t possess. For example, Tintinalli dismisses the utility of end tidal capnography because arterial blood gases are more accurate – which is true, but totally useless when your service can’t do it prehospitally. This is more of a ‘nice to know’ thing rather than an essential book.

The alternative: Rosen’s Emergency Medicine. Some people flat out prefer Rosen’s over Tintinalli – and I’m almost in that camp, except that Rosen’s deathbricks of paper are way more expensive. I think Rosen’s is written better and probably has a better presentation than Tintinalli, but I don’t know if the difference is really all that important. Rosen’s does seem a bit less easier to reference though – it’s more of a ‘sit down and read’ book rather than ‘skim quickly to find an answer.’

Primary Clinical Care Manual (QLD Government/RFDS) Free. This is a free Qld State Gov resource that covers a load of rural emergency protocols, which you might find helpful. While it’s mostly protocol-based, it does offer some insight into other emergency care pathways that your patient might go through.

Minor Emergencies (Buttaravoli) $62 AUD. You will go to a lot of minor crap as a paramedic. You might be able to direct them to other pathways or better make a decision about the risk of these minor incidents by reading this book. Covers a load of little conditions along with treatment pathways and red flags to watch out for. Not essential by any means (and some of it may be covered, if only in passing, in other books) but still a useful little guide for ridiculous shit we go to.

Manual of Emergency Airway Management (Walls, Murphy) $86 AUD. This has long been the definitive text in airway management. While some of it has since been included in other textbooks, it still offers an excellent insight into how to manage airways, from the simple to the absurdly complicated. Really good book worth grabbing a copy of it, especially if you plan on upgrading to intensive/critical care (where intubation will become a major skill).

Lippincott Pharmacology Review: My university had an awful pharmacology program, and yet pharmacology is really important. To be honest, you can Google pretty much anything you need to know, but a decent pharmacology book isn’t a bad thing to have on hand anyway. Lippincott’s Review is to the point, without a lot of the extraneous cruft that other pharmacology books have. Good for reviewing pharmacology concepts of the major drug classes. It also includes a bit of relevant physiology too.

Paramedic Principles and Practice ANZ: This is an Australian book that I’d highly recommend considering – especially during your degree. If it was expanded, I’d actually make it an essential recommendation. Basically, this book is about clinical decision making moreso than management. It presents a good approach to patient assessment, covers a number of common presentations, and steps through a couple of cases (one that matches the ‘textbook’ presentation, and some that are more ambiguous). Unfortunately, it doesn’t cover everything (hypoglycaemia is covered, but hyperglycaemia isn’t – go figure), and it won’t teach you any procedural skills, but it’s great at teaching clinical decision making. If it was less expensive I’d doubly recommend it – but as it stands, it’s only worth getting if you’ve got the money spare, or have a special interest in it.

Anatomy and Physiology Textbook… maybe. Most universities have a decent anatomy and physiology course that really won’t need the textbook too much (they try to teach you everything), but if you want a textbook (for future reference) there are many options out there.

  • Ross & Wilson Anatomy and Physiology in Health and Illness is a popular one that’s been around for ages. It’s very easy to read and quite straightforward. If you just want a fairly functional overview of anatomy and physiology, I’d pick this one.
  • Principles of Anatomy and Physiology (Tortora) is another extremely popular book, and it’s a goddamn brick too. If you want something that’s more in depth, I’d pick this book. It’s still very easy to read but it goes into more detail than will probably be strictly necessary for most degrees.
  • Grey’s Anatomy and Medical Physiology (Guyton and Hall) is the oldschool medschool way – one book that deals exclusively with anatomy (in excruciating depth), and another for physiology (also in significant depth). I’d say this is absolute overkill for most paramedics, especially reading through Grey’s Anatomy, but hey, it’s your call.

Books I’d Avoid

Some books are awful. Some just aren’t that good. Here are some books that I’d suggest you avoid – for various reasons.

  • Emergency and Trauma Care for Nurses and Paramedics. I hate this textbook for many reasons – it’s poorly set out, it’s confused in its approach, its patient assessment sections are a total mess, and its images aren’t great. But the biggest sin is lumping paramedics in with emergency nurses. Our work environments are fundamentally different, but the book neglects this. You’ll learn an awful lot about nursing interventions in the ED, but not a lot about prehospital care or proper patient assessment. Some sections are really good, and show promise – but lots of them are awful. It’s sad because it’s an Australian book that has become popular at universities, but it’s honestly way more useful for double-degree students (which is probably why they like to use it).
  • Mosby’s Paramedic Textbook/Sander’s Paramedic Textbook. Not an awful book by any means (I had Sanders in my degree), but there are better books out there. Mosby’s sits firmly between Caroline and Bledsoe (see next book) – not too basic, but not too technical. One thing I hate though is that it asks a lot of questions of the reader – but then never answers them, so you have no idea if your answer is right or wrong! The difference between Mosby and Sanders is simply locale – Sanders is UK-based while Mosby is US-based. This changes treatment protocols and some measurements, but otherwise is the same.
  • Paramedic Care – Principles and Practice. I actually love this series of books and Dr Bledsoe’s contribution to EMS education is outstanding, but I don’t recommend them to new Australian students Why? They gloss over some fundamentals that are covered in an EMT-B book, and we can’t justify buying an EMT-B book (which aren’t cheap!) to fill in the gaps. Bledsoe’s books easily offer the most depth, but it assumes you know how to be an EMT-B first – and you don’t.
  • Tintinalli or Rosen’s as a first textbook. Yeah, nah, don’t do this as a rule – some people might manage this, but by and large most people I’ve seen try to do this end up with no real idea of what they’re doing. Neither of them are written for prehospital care. Neither of them will help you all that much when you’re treating someone upside down in a wrecked car. Save them for later – when you’ve got a solid foundation.
  • EMT-focused anatomy and physiology textbooks. While none of these are particularly bad or awful, they tend to lack depth in some areas, and for the price you can usually just get a more general A&P textbook that offers more information. There are better options, generally speaking.
  • PHTLS, AMLS, PALS, ITLS, etc. There are many of these ones floating around, but for Australian students, they tend not to be overly useful. None of them are bad books, and they can be useful books – but a lot of what they teach is already included in other books (at least the best bits are), and they’re mostly designed to go along with an actual course. If you want them, get them second hand – don’t pay full price, they’re not worth it. The one exception is POET (Prehospital Obstetric Emergency Training) – that’s actually a pretty decent book.
  • Fundamentals of Paramedic Practice. I don’t see any Australian unis recommending this book – and hopefully they never do, because it’s almost entirely devoid of useful information.

Final words

I want to address a few common statements I see being brought up about paramedic textbooks. I respond to these as a tertiary educated officer – in other words, I come from the system that many of the people who make these arguments wish they came from.

“Your book is too basic in its language, it’s out of date, and it’s worthless. Get a nursing textbook or a medical textbook instead.” Textbooks go out of date as soon as they’re printed, and many paramedic textbooks are written to be easy to understand. You know what? My nursing degree had loads of texts that were written like Nancy Caroline, and some were even worse! They’re not designed to be journal articles written for industry insiders – they’re introductory texts teaching new material. They’re supposed to be easy to grasp. Do they offer simplified explanations? Yes, because they’re trying to cover loads of material in a single book (or a few books) – it’s always going to be truncated. The venerable Tintinalli is often considered too long winded and overblown by medical students, yet it’s held up as the be all and end all of texts in EMS. As for using only a medical book: it won’t teach you jack shit about actual prehospital management, especially when it’s telling you to make a diagnosis based on diagnostic tools you don’t have access to. We work in a world of unknowns and best guesses with limited information – Tintinalli won’t account for that, but a paramedic text will. I’ve long since learned that the number of words over 8 letters is not the metric of a good textbook.

“Textbooks are useless, just read journal articles.” Interestingly enough, a university in my city tried this method. They called it ‘evidenced based practice’ and it failed miserably. Students would come in saying that they didn’t learn protocols, they learned ‘the evidence’ – and then couldn’t figure out how and when to give GTN (they must have skipped that article?). Nobody, not even med students, learn this way. Textbooks give you the basics, the fundamentals – they won’t tell you everything, nor will what they tell you always be up to date – but they get you started with the background that allows you to go further. They’re the entry point and nothing more. Journal articles offer evidenced-based opinions or recommendations on various medical topics – which may go into practice guidelines. They help inform a knowledgeable practitioner on what apparently works or doesn’t work. This applies to FOAMed as well – great for continuing education, awful for starting from square one.

“Don’t get a paramedic textbook, just study A&P instead.” Well, I do recommend staying anatomy and physiology – it’ll help immensely, and the A&P in paramedic textbooks are oversimplified by necessity. Also, you don’t get a choice in a degree program. But an A&P book won’t teach you how to assess patients or how to manage conditions.

“Don’t get a textbook, just go to lectures. A lot of students stick by this, and while some get away with it in terms of marks, you often notice a deficit in their skills while on placement. Lectures and tutorials tend to fit into 4 hours a week – barely enough time to cover anything in actual depth. That’s why universities set weekly readings – so that you learn more about the topic. The idea is that you read before you come to class – but unfortunately, due to the obscene pricing of textbooks, many students never buy them and never use them. As a result, the university can’t reserve advanced concepts for the lectures and instead retread the basics. Plenty of people do this, but the ones who actually pick up a book and read it end up having a better understanding of the topic, rather than those who rely on dot points from a PPT and the rantings of whatever tutor they got for that tutorial.

Paramedic textbooks aren’t perfect and won’t teach you everything. They go out of date as soon as they’re printed, they often don’t match up with your local guidelines, and new editions aren’t cheap. But they do cover the fundamentals nicely. For these reasons, I wouldn’t stress too much about what paramedic textbook you get. Rather, you need to make sure it has a good foundation in the basics of care – airway/ventilation management, circulatory management, patient assessment, and principles of care for a variety of conditions. The specifics don’t matter except for the ABCs.

 

 

 

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