Top Ten Tips Palliative Care Clinicians Should Know About Improving Partnerships With Emergency Medical Services

Wang, David H.; Breyre, Amelia; Brooten, Justin K.; Hanson, Kenneth M.

doi:10.1089/jpm.2022.0537

Cited by 5 publications

(5 citation statements)

References 27 publications

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Section: Discussionmentioning

confidence: 99%

“…38 Moreover, paramedicine has traditionally prided itself as a discipline of independence and autonomy, perhaps reinforcing hierarchies and siloes of care, and hindering opportunities for establishing communities of palliative care practice. 19,39 However, the COVID-19 pandemic has expediated the settings in which paramedics can work, highlighting opportunities for these skilled clinicians to join multidisciplinary teams in general practice and palliative care settings. 1,40 This approach has resulted in congenial relationships across disciplines, foreshadowing opportunities for future integrated models of community-based palliative care.…”

Section: What This Study Addsmentioning

confidence: 99%

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‘It breaks a narrative of paramedics, that we’re lifesavers’: A qualitative study of health professionals’, bereaved family members’ and carers’ perceptions and experiences of palliative paramedicine

Juhrmann,

Butow,

Platts

et al. 2023

Palliat Med

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Background: Paramedic practice is diversifying to accommodate evolving global health trends, including community paramedicine models and growing expertise in palliative and end-of-life care. However, despite palliative care specific clinical practice guidelines and existing training, paramedics still lack the skills, confidence and clinical support to provide this type of care. Aim: To elicit paramedics’, palliative care doctors and nurses’, general practitioners’, residential aged care nurses’ and bereaved families and carers’ experiences, perspectives, and attitudes on the role, barriers and enablers of paramedics delivering palliative and end-of-life care in community-based settings. Design: A qualitative study employing reflexive thematic analysis of data collected from semi-structured online interviews was utilised. Setting/participants: A purposive sample of 50 stakeholders from all Australian jurisdictions participated. Results: Five themes were identified: positioning the paramedic (a dichotomy between the life saver and community responder); creating an identity (the trusted clinician in a crisis), fear and threat (feeling afraid of caring for the dying), permission to care (seeking consent to take a palliative approach) and the harsh reality (navigating the role in a limiting and siloed environment). Conclusion: Paramedics were perceived to have a revered public identity, shaped by their ability to fix a crisis. However, paramedics and other health professionals also expressed fear and vulnerability when taking a palliative approach to care. Paramedics may require consent to move beyond a culture of curative care, yet all participant groups recognised their important adjunct role to support community-based palliative care.

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Section: Discussionmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

‘It breaks a narrative of paramedics, that we’re lifesavers’: A qualitative study of health professionals’, bereaved family members’ and carers’ perceptions and experiences of palliative paramedicine

Juhrmann,

Butow,

Platts

et al. 2023

Palliat Med

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“…Recent publications have focused on the interface between palliative care and the EMS (6,(13)(14)(15), but we found very limited data on the specific needs of children and their families.…”

Section: Introductionmentioning

confidence: 86%

“…This has led to an increasing number of palliative care teams (PCTs), including some for children ( 3 , 4 ), and more children and adolescents with LLCs are being treated at home ( 3 ). Conditions requiring palliative care are diverse and affect children with cancer, heart disease, rare syndromes, trauma sequelae, asphyxia, metabolic diseases, and conditions of other pediatric subspecialties ( 2 , 5 , 6 ). These conditions may be stable but also prone to complications including seizures and pneumonia ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Implementation and evaluation of a palliative care training unit for EMS providers

Hauch,

El Mohaui,

Sander

et al. 2023

Front. Pediatr.

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BackgroundThe prevalence of children with life-limiting conditions (LLCs) is rising. It is characteristic for these children to require 24/7 care. In emergencies, families must decide to call the emergency medical service (EMS) or a palliative care team (PCT)—if available. For EMS teams, an emergency in a child with an LLC is a rare event. Therefore, EMS providers asked for a training unit (TU) to improve their knowledge and skills in pediatric palliative care.Aim of the studyThe questions were as follows: whether a TU is feasible, whether its integration into the EMS training program was accepted, and whether an improvement of knowledge can be achieved.MethodsWe designed and implemented a brief TU based on findings of a previous study that included 1,005 EMS providers. The topics covered were: (1) basics in palliative home care, (2) theoretical aspects, and (3) practical aspects. After participating in the TU, the participants were given a questionnaire to re-evaluate their learning gains and self-confidence in dealing with emergencies in pediatric patients with LLC.Results782 (77.8%) of 1,005 participants of the previous study responded to the questionnaire. The average age was 34.9 years (±10.7 years SD), and 75.3% were male. The average work experience was 11.4 years (±9.5 years SD), and 15.2% were medical doctors. We found an increase in theoretical knowledge and enhanced self-confidence in dealing with emergencies in patients with LLC (confidence: before training: 3.3 ± 2.0 SD; after training: 5.7 ± 2.1 SD; min.: 1; max.: 10; p < 0.001). The participants changed their approaches to a fictitious case report from more invasive to less invasive treatment. Most participants wanted to communicate directly with PCTs and demanded a standard operating procedure (SOP) for treating patients with LLC. We discussed a proposal for an SOP with the participants.ConclusionEMS providers want to be prepared for emergencies in children with LLCs. A brief TU can improve their knowledge and confidence to handle these situations adequately. This TU is the first step to improve collaboration between PCTs and EMS teams.

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“…6,7 Even though previous studies have suggested that palliative care interventions in the ED could prevent unnecessary admissions and reduce both the length of hospitalization and costs, emergency medicine physicians, especially residents and young doctors, might have limited specialistic education and resources to provide a correct management of palliative care patients. 8 This lack of knowledge and practice has been highlighted by the COVID-19 pandemic, during which the increased demand for emergency department services resulted in limited resources and staff to provide quality palliative care. The situation clearly demonstrated that, especially during times of crisis, emergency department protocols should incorporate palliative care and seek innovative tools which can allow for better management of palliative care patients and emotional/spiritual support of families.…”

Section: Introductionmentioning

confidence: 99%

A narrative review on palliative care in the emergency department: dealing with the uncertainty of death

Porta

Mauri

2023

Emerg Care J

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In the last decades emergency physicians have observed a steep increase in the emergency department (ED) admissions of palliative care patients who rely on the hospital for symptoms’ relief and management of acute exacerbations of their chronic disease. Previous studies have suggested that palliative care interventions in the ED could prevent unnecessary admissions and reduce both the length of hospitalization and costs. However, emergency medicine physicians might have limited specialistic education and resources to provide a correct management of palliative care patients and avoid futile interventions. Thus, we aim in this narrative review to provide the reader with an introduction on the principles that should guide the emergency physician in a correct approach to palliative care patients in the ED. We will explain how to deal with the intrinsic prognostic uncertainty of palliative care patients by implementing a correct ethical approach which encompasses the understanding of both appropriateness and futility of intervention; furthermore, we will present practical tools such as scores and trials.

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Top Ten Tips Palliative Care Clinicians Should Know About Improving Partnerships With Emergency Medical Services

Cited by 5 publications

References 27 publications

‘It breaks a narrative of paramedics, that we’re lifesavers’: A qualitative study of health professionals’, bereaved family members’ and carers’ perceptions and experiences of palliative paramedicine

‘It breaks a narrative of paramedics, that we’re lifesavers’: A qualitative study of health professionals’, bereaved family members’ and carers’ perceptions and experiences of palliative paramedicine

Implementation and evaluation of a palliative care training unit for EMS providers

A narrative review on palliative care in the emergency department: dealing with the uncertainty of death

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