Feb 1, 2022
This episode features Madeleine Juhrmann (Northern Clinical
School, University of Sydney, Sydney, NSW, Australia. HammondCare
Centre for Learning and Research in Palliative Care, Greenwich
Hospital, Greenwich, NSW, Australia).
Global demand for palliative care is increasing and the reliance on
exclusively specialist hospital-based care is becoming
unsustainable. Community preferences also favour home-based deaths.
Paramedics are in a unique position to help deliver palliative
and end-of-life care in the home, especially after-hours for
palliative care emergencies. However, their role is traditionally
limited to providing life-sustaining interventions for acute
emergencies and conveyance to hospital. No overview of the role
paramedics play in delivering palliative and end-of-life care in
community-based settings currently exists.
The findings of the review suggest paramedics can play an important
role in providing emergency support to patients approaching
end-of-life, help facilitate home-based deaths, and reduce
avoidable hospital admissions where this is the patient’s
preference. The review identified untimely access to documented
wishes, family discordance and the medico-legal ambiguity
associated with palliative paramedicine as key barriers
preventing paramedics from adopting a palliative approach to care.
Key enablers highlighted within the review include strengthening
communication and support channels with
multidisciplinary teams, targeted palliative care training for
paramedics, partnering in care with families and palliative care
specific clinical practice guidelines to broaden the current scope
of practice.
This review underscores the opportunities for health services to
consider paramedic involvement in integrated models of community
palliative care delivery, especially as an adjunct support in
palliative emergencies in collaboration with other services.
Further research developing and evaluating systems to enable
paramedics better access to patients documented palliative care
plans, targeted palliative care training programmes and
palliative care specific clinical practice guidelines is
needed.