Minimal Reading for Paramedics?

Alternatively: What books should I really consider buying?

Recently a student posed a question to me about what books I actually used the most for paramedic education. I thought about it for a bit, and realised that there were only two that I really used – the rest I just looked up online. I’ve written extensively on paramedic textbooks lately, but when I think about it, there aren’t that many textbooks that are worth getting. Some sections of the profession are enamoured with various texts – usually medical texts that most medical students won’t even purchase. That got me thinking – what really are the minimum books I’d buy?

Essential Reading?

Online resources for paramedics is still pretty limited; a lot of it is imported from the medical field, which to be fair is great for things like ECGs, but a lot of it doesn’t translate well to the prehospital field. Also while lectures and tutorials are generally fairly okay, they often leave a lot of unanswered questions or quickly glossed over concepts. I think textbooks, for the most part, still have a place in paramedicine.

A paramedic textbook is still useful, because it’s about prehospital care. You can pick whichever one you think sucks the least, but I’d still recommend having one around (at least to start with) because they focus on prehospital care. Are they perfect? No. Do they tell you everything? No. But they are written for people who work out of hospital with limited information – a kind of environment that many doctors don’t even feel comfortable working in. Therefore I think that these books still have merit, even if they’re not the greatest books ever written. The vast majority of important conditions you need to diagnose and treat are covered in these books, along with the fundamental pathophysiology surround them. They also teach you how to manage perfusion and ventilation when you’ve got nothing more than a NIBP cuff and end tidal capnography.

An ECG book on the basics. I don’t think buying a big ECG book is useful anymore. There are a plethora of resources on YouTube or Life in the Fast Lane for learning all the complicated details of ECGs. There aren’t quite so many on the fundamentals of ECGs though, so a book that holds your hand probably isn’t a bad thing. Whether that’s Dubin’s orange book, or something else, is up to you. Hell, your paramedic textbook might have a decent “fundamentals” section that will clean it up for you, eliminating the need for this.

An anatomy and physiology textbook – but probably a basic one. A book to refresh your knowledge of anatomy and physiology probably won’t go amiss. This is probably more optional unless you’re bad at A&P, at which point I’d strongly recommend it. Bledsoe’s book (Anatomy and Physiology for EMTs) is a decent start; Tortora’s Principles of Anatomy and Physiology is even better (but may be overkill – especially if your lectures are really good). Anything else you want to know can probably be covered by online resources.

Online Resources, and Helpful Books

Really, anything other than that probably isn’t required. There are a few helpful books that might be of assistance, and there are some great online resources too. For anything that isn’t in the textbooks above, these are the places I’d go to look it up:

For general reading: Wikipedia. Yes, Wikipedia is not the most reliable source; but it’s great for background reading on a bunch of different conditions and concepts. The hyperlinked nature means it’s easy to find extra information to understand what you’re reading about. Every discipline ever will tell you “Don’t use it to look up our information, but it’s fine for random unrelated thing.” No, it’s fine for background reading on almost anything. Just don’t hold it up as a defence, because it can be wrong.

Medscape and Merrick Manual. Both are free online resources that are better than any textbook you can name. Medscape is a bit more basic, but it’s easy to navigate and easy to understand. The Merrick Manual is a bit less friendly but offers a lot more information. Either one will serve you well for looking up different conditions, medications, and treatments. These are written and reviewed by actual clinicians, so you can trust them more than Wikipedia, and they’ll be more up to date than your textbook.

FOAMEd: While FOAMed (Free Open Access Medical Education) is presented as the silver bullet for textbooks, it really isn’t – it’s mostly useful as a continuing education resources on very specific topics. It’s great, and it’s especially good once you settle into your profession and are looking to learn more (or new ways of doing things), but it isn’t the best place to start.

Oxford Handbook of Clinical Medicine, and Handbook of Emergency Medicine. These two books are fairly small, often can be found second-hand for reasonable prices, and offer a wealth of quick reference information for all sorts of clinicians. It’s one of the few books a medical student actually purchases. If you want one that mostly focuses on general medicine, get the Clinical Medicine book. If you want one that focuses predominately on emergency conditions, get the Emergency Medicine one. Honestly, I keep both with me – the EmMed book is great for all sort of big name conditions, but the Clinical Med book covers a lot of common yet fairly benign conditions that we still see on a regular basis. Both are great, but not essential. One thing that they do offer is more information on approaching conditions and patient assessment considerations – something that quick online resources don’t really cover.

What I haven’t used much…

I have a lot of books. Some of them I used quite a bit when I first got them, but didn’t end up using them very much afterwards. Some of them I used because I was just too mistrusting of online sources. All of them are in some way limiting.

  • Tintinalli’s Emergency Medicine and Rosen’s Emergency Medicine – Both are good books and full of lots of useful information, but both are books that I very rarely make a lot of use of. Most of them aren’t relevant to prehospital care and have outdated information. They’re cumbersome to use and I can find what I need to know online much faster. Maybe more useful to the emergency intern, but not quite as useful for me as a paramedic as I’d been hoping.
  • Pharmacology books. I used Lippincott quite a bit to start with, and then I stopped. Why? I can find the same information online – Wikipedia is generally fine for background reading on how drugs work. Therapeutic uses and doses can be found on Medscape. It’s just not that useful.
  • Textbook of Adult Emergency Medicine (and Paediatric Medicine). Actually I do still use these a little bit; not an awful lot, but I occasionally check them for an Australian perspective, or to help with understanding diagnostic approaches to some conditions. But I don’t use them as much as I used to, because I can find most things online much faster. I hardly ever touch the paediatric one – I can’t make much use of it as a paramedic, because in my system we generally don’t leave kids at home as a rule.
  • PHTLS. I have the book and I’ve read it a bit, but most of the important information is already in a paramedic textbook, so I don’t really need it. The pictures are pretty cool though.

When I think about it, the books that teach me how to assess and generally manage patients in the prehospital environment are the most useful to me. Books that give me a solid foundation to stand upon are the ones that I still like to keep around (and occasionally refer back to). There aren’t many online resources that comprehensively tell you how to assess a patient with shortness of breath and the general management of that patient. There are lots about the pathophysiology of asthma, its signs and symptoms, the A&P of the airways, how salbutamol works, and so on… but not a lot about prehospital patient assessment. There are lots of resources that show you how to put in an LMA, or how to intubate, or how to gain IV access – but not a lot on when and why to do it in the prehospital environment, or how to give fluids and what your end goals are when there aren’t any fancy machines around you to help guide you.

The rest? Well, I never use them. I can just find information faster online. Why would I use a textbook?

So what books do I still like to use?

  • Nancy Caroline’s Emergency Care in the Streets. Yes, it’s not the best, but it’s the most basic, and it’s served me well when I decided to go back to the fundamentals of prehospital care to make myself a better clinician. Dead simple, solid fundamentals, helps refresh concepts I haven’t visited in a while. Honestly probably gets a bad rap for elitist reasons – it’s a good entry-level textbook that I recommend to Australian students (mostly because our robust degree-level education offsets any limitations). If I’ve forgotten something or I want to review a general prehospital care concept, I go back here.
  • Anatomy and Physiology for Emergency Care. Bledsoe’s book isn’t overly in depth, but it’s good enough to quickly review concepts that I’ve forgotten. For anything more in depth, I can look it up online. I also got it really cheaply for the Kindle (it cost me less than $10 – the cheapest A&P book around). Doesn’t crack into too much cellular stuff and is a little too basic in some areas, but by and large it does the job I need it to do.
  • Oxford Handbooks. I have the Clinical Medicine, Critical Care and Emergency Medicine books – I mostly use the EmMed and CMed ones. I also have the Prehospital one but it’s not overly useful. I mostly use them to help with patient assessment – for example, if I’m going to an eye emergency, I’ll read up on eye problems to help me with assessing the patient and identifying possible causes.
  • Dubin’s Rapid Interpretation of EKGs. Not something I use very often, but I do sometimes use it as a teaching aid for students. It’s simple as dog shit to understand. Bit out dated and some concepts aren’t covered very well – but that’s why we have Life in the Fast Lane’s excellent ECG library to cover it!

Outside of that? I barely use textbooks. There’s only one more textbook I’d like to get my hands on (a critical care textbook) to help me learn more about critical care in the prehospital environment – but otherwise I really don’t see much of a need for other textbooks. The books above aren’t exceptionally cheap, but I acquired them over a period of time and they actually have made a difference to my patient care skills (well, Caroline and the Oxford EmMed handbook did – the A&P and Dubin books are just revision). If I wanted to learn anything outside of these, it’s frequently easier to just start Googling – and the information is usually sufficient for someone of my level to get an understanding of it. By using appropriate online clinical resources, it can also aid me in making decisions.

Do I think textbooks are dead? Nope, far from it – they serve an important place for understanding the fundamentals of our profession. Nobody has really worked on a good online resource that talks you though the basics. We lament that textbooks don’t tell us more, or aren’t always up to date, but textbooks are entry-level instruction books designed to lay a solid foundation. That’s their real value. For anything more advanced than the basics, you can find information online much more easily. Want to learn about Serotonin Syndrome? It’s explained much better online than in your textbook.

So if you’re a student trying to work out whether or not to get textbooks, I’d say that some of them are extremely helpful – and those books are all there to cover the fundamentals of prehospital care, or to serve as useful reference handbooks for when you need to learn more about assessing patients and interpreting your assessment data. But for learning about specific conditions, drugs, up to date treatments and the like – online is better.

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