Compassionate resuscitation

Podcast – Compassionate Resuscitation with Matt Hooper at LTC

In the fast-paced world of emergency medicine, life and death often feel like binary outcomes. Yet, as Dr. Matt Hooper, an intensivist and palliative care specialist, discussed at the London Trauma Conference, there’s a middle ground that we as healthcare professionals must explore: how to integrate compassionate end-of-life care into acute settings. This podcast delves into the key themes of Matt’s talk and offers actionable insights for health professionals aiming to provide dignified, holistic care at the most critical moments.


Listening time: 24.57

Reframing Death in Emergency Medicine

Matt emphasized that modern emergency medicine has become synonymous with life extension and survival. While these goals are central to the discipline, they should not overshadow the importance of a “good death” for patients whose lives cannot be saved. He cited a 1984 quote that highlighted the need to assess not only survival but also the quality of life, the quality of death, and the quality of relationships surrounding a patient’s passing.

Recognizing death as a natural part of life—and not as a failure—is a crucial step in shifting this mindset. For emergency practitioners, this involves reevaluating our metrics of success and embracing care strategies that prioritize comfort and dignity when life-saving interventions are no longer appropriate.


Three Key Stakeholders in End-of-Life Scenarios

Dr. Hooper identified three groups affected by end-of-life situations in emergency settings:

  1. The Patient: Providing comfort and dignity should be central to care, even in environments like emergency departments or pre-hospital settings.
  2. Witnesses to Death: Families, bystanders, and colleagues are often secondary casualties. Matt emphasized the importance of recognizing their emotional needs to help them process grief and avoid long-term trauma.
  3. Healthcare Providers: Responders often carry an “accumulated burden of grief,” which can lead to burnout or PTSD. Addressing emotional connections to patients and their families can be preventative, fostering resilience instead of emotional detachment.

Bridging the Gap: Applying Palliative Care Principles in Acute Settings

The Importance of Communication

Matt stressed the need for clear, compassionate communication. Avoid terms like “withdrawing care” or “ceiling of care,” which can imply abandonment. Instead, frame the shift as one that focuses on comfort and dignity. By saying, “I guarantee we will do everything necessary to ensure their comfort and respect their dignity,” you help families feel supported without burdening them with decisions beyond their expertise.

The Role of Silence

Silence can be a powerful tool. When presenting difficult truths to families, resist the urge to over-explain or fill pauses. This gives them space to process information and respond meaningfully.

The Pause

One specific technique Matt highlighted is “The Pause,” a practice borrowed from hospice care. After a patient has died, the team collectively acknowledges the life that has ended. A simple, non-denominational script can help:

“Before we move on to care for others, let’s take a moment to honour [the patient]. They were someone’s loved one, and their life mattered. We value the opportunity to have cared for them.”

This practice not only supports the emotional health of the team but also humanizes the experience for witnesses and family members.


Training for Compassionate Resuscitation

While postgraduate palliative care qualifications, like those Dr. Hooper pursued, may not be feasible for all practitioners, there are ways to build competency:

  1. Use the Surprise Question: Ask, “Would you be surprised if this patient died in the next 12 months?” This simple tool helps identify patients who may benefit from early palliative interventions.
  2. Develop Communication Skills: Attend short courses or workshops that focus on breaking bad news, active listening, and handling emotionally charged situations.
  3. Leverage Resources: Explore literature and case studies on integrating palliative principles into emergency care.

Matt also called for the development of structured “last aid” training—a curriculum akin to first aid but focusing on end-of-life care.


The Emotional Toll on Healthcare Providers

Healthcare providers are often reluctant to confront their emotional responses to death, fearing it might impair their professionalism. However, Dr. Hooper argued that acknowledging and addressing these feelings can enhance resilience and empathy. Leaning into the discomfort of difficult conversations or emotionally charged scenarios, rather than avoiding them, allows practitioners to build emotional stamina and provide better care.


A Vision for the Future: Compassionate Resuscitation

Matt proposed merging the principles of acute care and palliative care into a unified framework he calls “compassionate resuscitation.” This approach emphasizes the following:

  1. Treat What is Treatable: Focus on reversible and manageable conditions while recognizing when interventions may cause more harm than benefit.
  2. Humanize Care: Utilize soft skills such as touch, eye contact, and tone of voice to comfort patients and families.
  3. Respect Individual Paths: Acknowledge that patients “die as they have lived,” and allow their values to guide care decisions.

Practical Takeaways for Health Professionals

  • Incorporate The Pause: Make it a routine part of your practice to acknowledge death, both for the team and for those grieving.
  • Foster Open Dialogue: Normalize discussions about end-of-life care within your team and with patients and families.
  • Seek Training Opportunities: Engage with resources that improve your ability to identify and respond to end-of-life scenarios.
  • Advocate for Change: Work within your institution to develop policies and training programs that prioritize compassionate end-of-life care.

Conclusion

Matt’s insights challenge us to rethink how we approach death in emergency medicine. By integrating palliative care principles into our practice, we can provide care that is not only clinically excellent but also deeply humane. Compassionate resuscitation is not about choosing between life and death—it’s about honouring the full spectrum of the human experience.


Podcast Transcription


The Guest – Dr Matt Hooper

Matt is an accomplished intensive care specialist with a diverse background in emergency medicine, prehospital & retrieval medicine, and palliative care.

Notable for his leadership in developing critical care service models, he founded South Australia’s MedSTAR Emergency Medical Retrieval Service. He has also co-authored a highly regarded case-based text book and held key teaching and examining roles nationally and internationally in prehospital and retrieval medicine.

With a strong focus on high-performance teams working within high acuity, high consequence environments, Matt’s expertise has also extended to human factors in healthcare, cardiothoracic intensive care, ECMO, and clinical ultrasound. More recently however, he has pivoted towards palliative and end of life care, pursuing a Master’s degree at Cardiff University and consulting at Mary Potter Hospice in Adelaide. He is passionate about exploring new and innovative ways to prevent potentially avoidable suffering and enhance end of life outcomes for patients in acute care clinical environments.


Where to listen

You can listen to our podcast in numerous ways, ensuring you never miss an episode no matter where you are or what device you’re using. For the traditionalists, Apple Podcasts and Google Podcasts offer easy access with seamless integration across all your Apple or Android devices. Spotify and Amazon Music are perfect for those who like to mix their tunes with their talks, providing a rich listening experience. If you prefer a more curated approach, platforms like Podchaser and TuneIn specialize in personalising content to your tastes. For those on the go, Overcast and Pocket Casts offer mobile-friendly features that enhance audio quality and manage playlists effortlessly. Lastly, don’t overlook YouTube for those who appreciate a visual element with their audio content. Choose any of these platforms and enjoy our podcast in a way that suits you best!


Cite this article as: Iain Beardsell, "Podcast – Compassionate Resuscitation with Matt Hooper at LTC," in St.Emlyn's, January 29, 2025, https://www.stemlynsblog.org/podcast-compassionate-resuscitation/.

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