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ACLS for EMT-Basics
  1. M Woollard

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    M Smith, Sudbury, MA: Jones and Bartlett Publishers, 2003, $31.95 (paperback), pp 120. ISBN 0-7637-1505-0

    In the UK, most ambulances are staffed with one technician and one paramedic—a skill mix that results in particular challenges when managing cardiac arrests. British emergency medical technicians (EMTs) are routinely taught to support paramedic activities and a chapter of their Basic Training Manual is devoted to this topic.1 The review book therefore has the potential to provide additional in depth information for UK EMTs and others working alongside Advanced Life Support colleagues.

    The book encompasses airway management, emergency cardiac care, abnormal ECG recognition, defibrillation and pacing, pharmacology of cardiac emergency drugs, special resuscitation situations, legal issues, and stress. It is attractive and includes plenty of pictures, sidebars, and a comprehensive index. Moreover, it minimises the risk of appearing daunting to its proposed audience of EMTs in basic or continuing training, as it is no thicker than the average Sunday newspaper supplement.

    The author has clearly struggled with considerations about what material to incorporate, but unfortunately has not resolved this issue consistently. For example, the airway chapter describes basic manoeuvres and adjuncts in great detail but does not mention the recovery position. Endotracheal intubation is described at length, but intermediate adjuncts such as the Combitube are ignored. There is no explanation of how devices for confirming endotracheal tube placement are used; positioning of defibrillation pads/paddles and energy level selection are not described; the pathophysiology of angina is described but that of myocardial infarction is not; neither aspirin nor thrombolytic agents are mentioned in the pharmacology chapter; and tPA is identified as a treatment of stroke but not of myocardial infarction. The limited number of arrhythmias accompanied by illustrations suggests the text is unlikely to facilitate the recognition of abnormal ECGs.

    The language used is an odd mixture of patronising simplicity (“Lidocaine is used to lessen the pain of an irritable, hurting heart”) and potentially impenetrable medical jargon (the terms “half-life” and “fibrillation threshold” are mentioned but not explained). Confusingly, the text alternates between the perspective of an EMT observing a paramedic and that of a paramedic undertaking a procedure. This risks leaving readers with the inappropriate impression that it is, for example, an EMT’s responsibility to correct intubation of the oesophagus.

    The book contains important errors. It implies that the earlobes are level with the angle of the jaw; that crystalloids remain within the vascular compartment; that selection of the correct diameter of nasopharyngeal airway should be based on the patient’s sex; and that “an unrecognised oesophageal [ET] tube still works to isolate the lungs”. An ECG purporting to show a prolonged p-r interval is printed in reverse, rendering it useless.

    Sentence construction often renders the text difficult to read and introduces the potential for some entertaining misunderstandings. For example, “Automated implantable cardiac defibrillators usually are placed into patients with a history of a near-death experience” and “The [defibrillation] current is delivered through the pads or paddles of the machine while on the patient’s chest”.

    Some ambulance technicians may feel that this book should be subtitled “EMTs are capable of much more than carrying the paramedic’s kit”. As such, it has the potential to fulfil an important unmet need. Sadly, it fails to do so through poor attention to detail and a lack of consistency in the level of clinical information it seeks to deliver to its target audience.

    M Smith, Sudbury, MA: Jones and Bartlett Publishers, 2003, $31.95 (paperback), pp 120. ISBN 0-7637-1505-0

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