Paramedic care of the dying, deceased and bereaved in Aotearoa, New Zealand

Abstract

Paramedics play an essential and distinct role as providers of care to the dying, deceased and bereaved in Aotearoa, New Zealand and around the world. In this paper, we highlight what is known about the features, barriers and facilitators of quality end-of-life care by emergency ambulance personnel. We also identify priorities for future policy and practice, education and research in this area.Paramedics provide urgent and after-hours support to those with known life-limiting illness and their caregivers, but also attend sudden deaths, from unexpected or unknown causes. Paramedic care at the end of life may involve attempted resuscitation; challenging decision-making and communication; symptom relief; recognition of irreversible dying; provision of compassionate, culturally responsive support for co-responders, bystanders and the bereaved. There is an insufficient acknowledgement of the critical and unique role of paramedics, as providers of urgent care to the dying deceased and bereaved. Ambulance personnel around the world want better preparation and support for end-of-life care. Future research should aim to evaluate and improve this vital care, explore the needs and experiences of those who call an ambulance in the context of death, dying or bereavement and address equity and cultural responsiveness.

Paramedics’ experiences and educational needs when participating end-of-life care at home: A mixed method study

“…This may be one of the sources of anxiety which paramedics need to handle with as the patient's family and caregivers need their support even when the death is anticipated. 41 In this, and some previous studies 8,17,19,22,23,32,40 paramedics expressed a need for regular training in end-of-life care. Improving their skills in end-of-life care might reduce feelings of stress.…”

“…This may be one of the sources of anxiety which paramedics need to handle with as the patient’s family and caregivers need their support even when the death is anticipated. 41…”

What is the role of paramedics in palliative and end of life care?

“…8,9 Simulation training has been found to be very useful in end-of-life care education as it allows paramedics to work through realistic clinical scenarios in a protected environment and ask questions of palliative specialists and explore issues which are not easily or readily explored in the traditional classroom setting, such as cultural differences in dying and the pressure of time critical practice. 10…”

Widening the conversation: Paramedic involvement in interprofessional care

“…Conversations about the need for advance care directives are often difficult to initiate, and as such, Goodwin et al 6 sought to identify paramedics' views on their involvement in proactive identification of patients in their final stage of life and the initiation of conversations regarding advance care planning in the United Kingdom. Both Anderson 7 and Cameron, 8 together with their colleagues, remind us that paramedics are often present at the time of death of a patient and that support of carers and family members at this time is a vital professional responsibility, yet paramedics may not be well supported or prepared for this role. This may include decisions to withhold or withdraw resuscitation.…”