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

Abstract

Background: Paramedics commonly face acute crises of patients in palliative care, but their involvement in end-of-life care is not planned systematically. Aim: To evaluate a protocol for end-of-life care at home including pre-planned integration of paramedics and end-of-life care wards. Design: Paramedic visits to patients in end-of-life care protocol were retrospectively studied. Setting/Participants: All of the patients who had registered for the protocol between 1 March 2015 and 28 February 2017 in North Karelia, Finland, were included in this study. Results: A total of 256 patients were registered for the protocol and 306 visits by paramedic were needed. A need for symptom control (38%) and transportation (29%) were the most common reasons for a visit. Paramedics visited 43% and 70% of the patients in areas with and without 24/7 palliative home care services, respectively ( p < 0.001); while 58% of all the visits were done outside of office hours. Problems were resolved at home in 31% of the visits. The patient was transferred to a pre-planned end-of-life care ward and to an emergency department in 48% and 16% of the cases, respectively. More patients died in end-of-life care wards in areas without (54%) than with (33%) 24/7 home care services ( p = 0.001). Conclusions: Integration of paramedics into end-of-life care at home is reasonable especially in rural areas without 24/7 palliative care services and outside of office hours. The majority of patients can be managed at home or with the help of an end-of-life care ward without an emergency visit.

Paramedics delivering palliative and end-of-life care in community-based settings: A systematic integrative review with thematic synthesis

“…40 These findings were supported by a retrospective cohort study evaluating paramedic attendance of patients with an end-of-life protocol. 36 However, despite many participants expressing concern over the level of suffering a palliative patient endures when undergoing life-prolonging treatment and transportation to hospital, four studies highlighted professional repercussions and fear of litigation as major barriers affecting a paramedic’s ability to move beyond hospital-oriented care. 20,26,27,29 Other studies explored this further, recognising the ethical dilemma and apprehension paramedics face when resuscitating a palliative care patient – a default procedure in many clinical practice guidelines – and expressed a strong desire to facilitate natural death despite often lacking the legal latitude.…”

“…17,21,22,24–26,28,30–32,34,38–41 Notably, in one study hospital-based death was reported for 54% of 252 patients in areas where paramedics did not have access to 24/7 palliative home care services, in comparison to 33% in areas where these services were available. 36 Paramedic length of service and end-of-life experience appeared to be other key factors facilitating paramedic confidence to treat a palliative patient. 22…”

“…A total of 23 studies were included in the review, as illustrated in Figure 1 (PRISMA flowchart). The studies derived from Australia ( n = 5), 25,26,28,32,37 Canada ( n = 2), 17,21 Finland ( n = 1), 36 Germany ( n = 4), 24,38,43,44 the United Kingdom ( n = 5) 20,22,29,30,31 and the United States ( n = 6) 27,34,39,40,41,42 between 2009 and 2020. Study methodologies varied and included qualitative ( n = 7), 17,20,26,29,30,39,42 quantitative non-randomised ( n = 3), 25,36,44 quantitative descriptive ( n = 8) 22,24,28,34,38,40,41 and mixed-methods studies ( n = 5).…”

“…The studies derived from Australia ( n = 5), 25,26,28,32,37 Canada ( n = 2), 17,21 Finland ( n = 1), 36 Germany ( n = 4), 24,38,43,44 the United Kingdom ( n = 5) 20,22,29,30,31 and the United States ( n = 6) 27,34,39,40,41,42 between 2009 and 2020. Study methodologies varied and included qualitative ( n = 7), 17,20,26,29,30,39,42 quantitative non-randomised ( n = 3), 25,36,44 quantitative descriptive ( n = 8) 22,24,28,34,38,40,41 and mixed-methods studies ( n = 5). 17,27,31,32,37 Sample sizes of the included studies were between 5 and 4348 participants; the majority of participants were ambulance staff ( n = 20), 17,20–22,24,26–32,34,37…”

“…37 Other studies supported these findings, acknowledging a change in paramedic scope of practice to enable better management of end-of-life patients required focussed educational interventions, 21,22,25,26,28,31,34,38–41,43,44 improved access to equipment and anticipatory medications, 30,31 strong linkages to palliative care specialist teams, 22,24,25,27,28,31,37,39 and end-of-life care clinical practice guidelines to standardise practice. 22,26,28,36…”