Palliative care in paramedic practice: A retrospective cohort study

Abstract

Background: Paramedics may be involved in the care of patients experiencing a health crisis associated with palliative care. However, little is known about the paramedic’s role in the care of these patients. Aim: To describe the incidence and nature of cases attended by paramedics and the care provided where the reason for attendance was associated with a history of palliative care. Design: This is a retrospective cohort study. Setting/participants: Adult patients (aged >17 years) attended by paramedics in the Australian state of Victoria between 1 July 2015 and 30 June 2016 where terms associated with palliative care or end of life were recorded in the patient care record. Secondary transfers including inter-hospital transport cases were excluded. Results: A total of 4348 cases met inclusion criteria. Median age was 74 years (interquartile range 64–83). The most common paramedic assessments were ‘respiratory’ (20.1%), ‘pain’ (15.8%) and ‘deceased’ (7.9%); 74.4% (n = 3237) were transported, with the most common destination being a hospital (99.5%, n = 3221). Of those with pain as the primary impression, 359 (53.9%) received an analgesic, morphine, fentanyl or methoxyflurane, and 356 (99.2%) were transported following analgesic administration. Resuscitation was attempted in 98 (29.1%) of the 337 cases coded as cardiac arrest. Among non-transported cases, there were 105 (9.6%) cases where paramedics re-attended the patient within 24 h of the previous attendance. Conclusion: Paramedics have a significant role in caring for patients receiving palliative care. These results should inform the design of integrated systems of care that involve ambulance services in the planning and delivery of community-based palliative care.

Preplanned participation of paramedics in end-of-life care at home: A retrospective cohort study

“…Although many symptoms share similar prevalence during the last months of life regardless of the disease, the severity of the most important ones (dyspnoea and pain) are high in patients with cancer and heart diseases, probably increasing the need for acute care. 17,28…”

“…[11][12][13][14] Paramedics are commonly involved in treating patients in palliative care at home after emergency calls in health crises and exacerbation of symptoms. 5,[15][16][17][18][19] Some of these issues could be taken care of at home by the paramedics and many drugs available in the ambulance could be used in symptom management. 16,17 However, paramedics are more familiar with life-sustaining interventions than the management of patients in end-of-life care and report receiving minimal training in palliative care.…”

“…5,[15][16][17][18][19] Some of these issues could be taken care of at home by the paramedics and many drugs available in the ambulance could be used in symptom management. 16,17 However, paramedics are more familiar with life-sustaining interventions than the management of patients in end-of-life care and report receiving minimal training in palliative care. 16,17,19 In addition, it is often difficult to arrange for out-of-hours care.…”

Widening the conversation: Paramedic involvement in interprofessional care

“…1 In countries such as Australia, these barriers to care in the community result in most calls relating to a palliative crisis being transferred by ambulance to an emergency department. 2 The contributions to this special issue describe initiatives that involve paramedics and ambulance services planning for care that may include a broader range of management options than the default option of transport to a hospital. It is recognised that patients may experience illness or injury that is unrelated to their palliative condition, and that health emergencies associated with a life-limiting illness may require hospital admission.…”

Paramedic delivery of community-based palliative care: An overlooked resource?

“…12 More recently, higher transport rates have been reported in Australia with approximately three-quarters of the 4348 palliative care patients who contacted a state ambulance service in a 12 month period were transported. 16 Caring for patients receiving palliative care may seem contrary to the traditional life-saving focus of paramedic practice, although paramedics appear to have a sound understanding of important aspects of palliative care with respect to symptom control and holistic care. 17 The core of the issue may lie in a lack of confidence and competence in managing palliative patients due to a perceived aperture in paramedic education.…”