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Book Review: Streetsense

Streetsense, Kate Dernocoeur’s updated volume of all things EMS, made me smile—not because of its comprehensive coverage of prehospital practices or its real-world recommendations for caregivers of all pedigrees, but because it’s so well written. That used to be a prerequisite for publication; now not so much, thanks to do-it-yourself options. We need literature as coherent as Streetsense to remind writers, if not readers, that improvised posts and tweets are no match for researched, polished prose.

Streetsense, the book, is primarily a vehicle to present Streetsense, the author’s patient-care philosophy focusing on EMS communication, safety, and control. Here are a few of my favorite parts:

  • The reminder that we’re in a service business buoyed by public trust. No amount of on-the-job frustration excuses boorish treatment of our customers.
  • Our reluctance to ask for help. Dernocoeur frames that tendency as a threat to safe lifting, but stubbornness is an obstacle to progress throughout EMS.
  • Managing fatigue with sleep instead of stimulants. As Dernocoeur says, “It’s amazing how refreshing a 20-minute nap can be.”
  • Her advice to ditch the sunglasses when meeting patients. That’s been a pet peeve of mine since I started seeing medics in full-tint mode indoors after dark.

The fourth edition of Streetsense speaks to the success of editions 1–3. Even a casual reading of this just-released version reveals Dernocoeur’s expertise as an educator and former paramedic. But casual reading is much less than Streetsense demands. Its style reminds me of modern people-management textbooks—intellectual yet conversational and densely packed with observations, aphorisms, and tips.

Chapters begin with bullet points and end with summaries. In between the author covers so many subjects in depth, I think most readers will prefer to parse the book into several weeks’ worth of study. The payoff? New ways of looking at what we do during and between calls.

Dernocoeur encourages field providers like you and me to view EMS with a mixture of idealism and practicality. Take safety. It’s supposed to be our top priority, but what if we’re faced with unknown casualties at an unsafe scene? And how can we reconcile the principle of doing no harm when we’re forced to defend ourselves against violent patients? These and other EMS paradoxes are confronted, appropriately, with more questions than answers.

Dernocoeur isn’t just an educator and a writer; she’s a student of humanity. She’s clearly taken advantage of many opportunities to observe people and relate their behavior to our industry. Not all of what she concludes is novel, and I would have liked to see more first-person stories to offset her scholarly takes on some topics, but I’m glad Dernocoeur didn’t leverage her 46 years in EMS to compose a series of life-and-death-in-the-streets narratives. I already have plenty of those on my bookshelves.

There’s lots to like about Streetsense. Its scope and structure alone make it worth a committed read. And Dernocoeur certainly has the creds to command the attention of her audience. But mostly Streetsense shows how one gifted paramedic can raise the bar for EMS literature.

Mike Rubin is a paramedic in Nashville and a member of EMS World’s editorial advisory board. Contact him at

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