Paramedics Play a New Role in Palliative Care

Paramedics are now trained to provide palliative care in the home and can access a database containing the patient’s goals of care.

Symptom crises such as pain and breathlessness are common near the end of life, whether a person is dying of illness or old age. Paramedics are often called to intervene in these frightening situations, but the typical paramedic protocol—stabilize and transfer to hospital—is often not in the best interests of these patients. 

“An ambulance ride and time in emergency is a stressful experience for anyone, even more so for patients approaching the end of life,” says Dr. Alix Carter, director of the Division of Emergency Medical Services at Dalhousie/NSHA and medical director of research at Emergency Health Services (EHS) Nova Scotia. “We wanted to know if training paramedics to provide palliative care in the home would reduce transfers to hospital and allow more patients to die with dignity at home.” 

Funding from the Canadian Partnership Against Cancer enabled Dr. Carter and her team to work with Pallium Canada to develop a training course to teach paramedics the essentials of providing palliative and end-of-life care. They also enhanced the existing EHS Special Patient Program, which now allows palliative care patients to register the goals of their care—symptom control and comfort—in a database that paramedics can access. 

Now Dr. Carter, project manager Michelle Harrison, and their team are evaluating the impact of these programs—launched province-wide in 2015— with funding from the NSHA Research Fund, a TRIC grant (funded by the QEII Foundation), CIHR (through BRIC NS), and support from the Canadian Foundation for Healthcare Improvement. 

“Our evaluations show that paramedics, patients and families are enthusiastic,” says Dr. Carter. “Paramedics feel well-prepared and confident to provide this care at home and patients and families are relieved to avoid unnecessary trips to hospital at such a vulnerable time.” 

The researchers are assessing key benchmarks of quality care—such as number of people who can spend the end-of life period at home. At the same time, through the BRIC NS project, they’re working with British Columbia to determine how such a program could be modified for rollout in other provinces.