Palliative care patients in the emergency medical service: a retrospective cohort study from Finland.

BACKGROUND: Paramedics are often involved in treating palliative care patients with difficulties regarding symptom control. They report minimal training in palliative care and find decision-making difficult. This often leads to overtreatment and unnecessary transportation to the emergency department. The study's objective is to determine how much palliative patients use emergency services, how well are they recognized by paramedics and how paramedics choose care in terms of treatment and transportation. METHODS: This study is a retrospective cohort study based in the Finnish Tampere University Hospital area. We included patients with a palliative care decision setting the goal of therapy as palliative intent between 1 August 2021 and 31 December 2021 and who died before 1 April 2022. From these patients, records of nurse paramedic visits were retrieved. Descriptive statistics were used to describe the data. RESULTS: Paramedics visited 69 patients in 97 callouts. These callouts comprised 0.26% of the total dispatches in the study area. The most common reasons for callouts were general weakness, breathing difficulty and pain. The paramedics provided treatment in 40% of the missions. 55% of the patients were transported to the emergency department. A palliative care plan was recognized by the paramedics in 42 of the 97 callouts. A total of 38 patients were recognized as palliative care patients by the paramedics while in the cases of 31 patients, palliative care was not recognized in any dispatch. CONCLUSION: Patients in palliative care cause only a minimal load on the emergency medical services, but the paramedics do not necessarily recognize them as such. This leads to the risk of overtreatment and a high transportation rate to the emergency department, which is not an ethical choice. Recognition and treatment provided to palliative care patients by the paramedics could be improved with additional training and greater availability of patient records.

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

BACKGROUND: Paramedics face end-of-life care patients during emergency calls and more recently through planned protocols. However, paramedics experiences and educational needs concerning preplanned end-of-life care at home remain largely unknown. AIM: To describe experiences and educational needs of the paramedics included in the end-of-life care protocol. DESIGN: A mixed method study with a questionnaire including open ended questions and numeric evaluations on a Likert scale. SETTING/PARTICIPANTS: The questionnaire was delivered to and answered by all the 192 paramedics working in North Karelia fire and rescue department during the time of the data collection in 2017. RESULTS: Over 80% of the paramedics agreed that the protocol helped them to take care of the patients and to improve the quality of end-of-life care. Visits to the patients were considered useful and the end-of-life care as a meaningful work by 76.5% and 62.5% of the paramedics, respectively. The paramedics expressed challenges in psychosocial aspects, communication, symptom management, and their role in end-of-life care. Encountering and communication with the families as well as managing the most common symptoms were emphasized as educational needs. Using a patient controlled analgesia device emerged as an example of practical educational aspect. CONCLUSIONS: Paramedics considered end-of-life care at home meaningful but called for more competency in supporting and encountering the families and in symptom management. Our results can be utilized when developing end-of-life care protocols and education for the paramedics. Patients' and families' views on the paramedics' participation in end-of-life care should be evaluated in the future.

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

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.