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Stefan Timmermans. Philadelphia: Temple University Press, 1999, $19.95, pp 256. ISBN 1-56639-716-2
Most emergency physicians will sometimes recognise a feeling of futility during cardiopulmonary resuscitation (CPR)—the algorithm is followed despite the fact that most of those present know the attempt is doomed to failure, or frankly inappropriate.
Stefan Timmermans is a Belgian healthcare sociologist who spent time in American emergency departments observing the rituals surrounding CPR. His book questions the notion of CPR for all, and the over-optimistic prognosis of survival from out of hospital cardiac arrest that is portrayed in the media, and by some medical authorities. The book describes the attitudes and feelings of doctors, nurses, and paramedics, their definitions of good and bad resuscitation attempts, and the way in which they feel constrained by guidelines and lawyers.
The chapters are wide ranging and include the evolution of resuscitations techniques, death awareness, and what constitutes a “good” death, as well as discussion on advance directives and the presence of relatives during resuscitation attempts. The author divides resuscitation attempts into four distinct categories, or trajectories, which will be familiar to all practising emergency physicians: the legal death trajectory, where resuscitation is performed mainly as a legal matter; the elite death trajectory where the victim is presumed to have high social viability and receives aggressive resuscitation irrespective of clinical viability (for example, the young); the temporary stabilisation trajectory, in which the patient is resuscitated despite the fact that the short term prognosis is poor; and the stabilisation trajectory, in which prompt resuscitation leads to a better outcome.
The book is written from a sociologist’s perspective, and therefore does not aim to provide answers—just observations. Yet despite the North American setting, it raises questions that are highly applicable to UK practice, and this book should be required reading for all ALS providers.