The Good Books

     As I head down the road toward 30 years as an EMS educator, one of the questions I am most frequently asked is where I go when I need more knowledge to solve a problem or answer a student query. While I certainly look far and wide for ways to help me learn more about prehospital medicine, there are four texts I use far more than any others. Listed below, you'll find what I call the "good books" and a brief rationale for what makes them work for me.

     Tintinalli's Emergency Medicine: A Comprehensive Study Guide

     The first edition of Tintinalli's came out in 1978, the year after I graduated from paramedic training. Though the intended market was physicians preparing to take their board certification examinations, I immediately saw the link to our work in the prehospital setting. With close to 400 authors, almost all MDs, PhDs or both, the depth and diversity represented in this text is remarkable. The insights shared on the topics under the umbrella of emergency medicine are impressive, to say the least.

     If this book is what physicians study as they prepare to take their emergency medicine board exams, it clearly meets and, in fact, goes beyond our needs in EMS. Still, when you have been a practicing medic for a couple of years, it's time to take your fund of knowledge to a different place. In a nutshell, to me that means accessing physician- level reference materials whenever possible. Of the many physician-focused texts, in my mind, Tintinalli's is a shining star in the night sky of emergency medicine.

     Goodman & Gilman's The Pharmacological Basis of Therapeutics

     In the early days of EMS, paramedic students were given a pharmacology "study guide" that in essence was no more than one sheet of paper per drug, giving the proprietary name and trade name, and progressing down the list: indications for use, contraindications for use, correct dose, route(s) of administration, side effects, etc.

     With the last major overhaul of the paramedic curriculum, that approach was shelved, and students didn't have to memorize each and every beta blocker, calcium channel blocker or whatever was on the market. They only had to memorize the essential characteristics of each class of drugs. Given the incredible number of drugs that enter the marketplace each year, there is some logic to this approach, yet it still leaves lots of gaps. For example, although the dosing schedules for Motrin and Aleve are very different, as are some elements of their mechanisms of action, both drugs are classified as NSAIDs.

     I personally consider Goodman and Gilman's the bible of pharmacology. When I need to really get a handle on the inner workings of a given pharmacologic agent, this is my go-to text. Granted, I may have to look up a few words here and there, but, in the end, it meets my pharmacologic knowledge needs seven days a week.

     Harrison's Principles of Internal Medicine

     It is often said that a thorough assessment of patients with medical problems will lead to a correct diagnosis. That has certainly been true in my practice. When I asked the right questions and then systematically sifted through all the information I had extracted, more often than not, I was on target with my patient care.

     That said, the grim reality remains that the body of knowledge in the field of internal medicine is both extremely wide and extremely deep—far beyond the knowledge required to become a paramedic. However, Harrison's will take you places you need to be if you want to be an outstanding paramedic.

     For the last 50 years, Harrison's has been a leading text in the discipline of internal medicine, and, in my opinion, remains so today. For those often challenging and sometimes obscure moments in internal medicine that make your head throb, Harrison's will get you up to speed fast.

     Taber's Cyclopedic Medical Dictionary

     When physicians write for other physicians, they write at a physician level. While we may share certain commonalities of medicine, most of what we read will be above our level.

     To address that issue, keeping a Taber's close by is mighty helpful when referencing physician-level materials. Not only will you gain a better understanding of what you are reading, there is the indirect benefit of being better able to dialog with a physician one-to-one as you expand your language-of-medicine capabilities. Just as a journeyman mechanic cringes when you call a half-drive ratchet a "thingamabob," a physician will cringe when you can't use the language of medicine correctly in a conversation.

     Having your Taber's nearby as you read physician-level materials will improve your volume of knowledge and speed of acquisition, as well as your overall comprehension.

     I know there are many great books out there to help the motivated paramedic continue to grow as a caregiver, but the aforementioned texts have been the "good books" for me. Maybe they will serve the same purpose for you.

     Until next month…

     Mike Smith, BS, MICP, is program chair for the Emergency Medical Services program at Tacoma Community College in Tacoma, WA, and a member of EMS Magazine's editorial advisory board.