It's not uncommon for patients and families to call paramedic services when they experience sudden changes in care or gaps in accessing home care services and supports. While traditional emergency medical service response is based on assessing, treating and transporting patients to the hospital, it’s not designed to meet the needs and wishes of patients requiring palliative treatment options for care.
This matters because three-quarters of people indicate they would prefer to die in their home. 1 However, this doesn’t happen as often as it could. Sixty-two percent of people living in Canada who receive palliative care do so in an acute care hospital and often in their last month of life. 2 As part of this project’s four-year collaboration, more than 6,000 paramedics across seven provincial teams were trained to provide patients with in-home support when they have a palliative emergency, require pain and symptom management or have an unexpected health event.
Evidence shows paramedics providing palliative and end-of-life care in the home improves the comfort and quality of life for people living with life-limiting illnesses, as well as their families and caregivers.3
The Paramedics and Palliative Care: Bringing Vital Services to Canadians program resulted in:
Early results also show that the program contributed to family satisfaction with the care they received and comfort in knowing that the program was available to them 24/7. Preliminary data demonstrates that despite longer on-scene times, the overall time of the call is shorter, especially in environments where there are long delays in transferring patients to emergency departments.
The Paramedics and Palliative Care change package provides core principles and elements required to develop and implement a palliative approach to care for paramedic services.
Through the program, paramedics were trained to assess people with palliative care needs (for example, pain management) and treat them on the spot at home. Paramedics are trained to provide this care without a transfer to hospital, if appropriate. Paramedic services are using a variety of training approaches and supports including LEAP (Learning Essential Approaches to Palliative Care) which is provided by Pallium Canada, MyGriefToolbox.ca developed by Canadian Virtual Hospice, and other education developed by teams as part of the program.
The program is contributing to:
This approach to person-centred care was identified through an open call for innovations in 2017 as the Paramedics Providing Palliative Care at Home Program in Nova Scotia and Prince Edward Island, and Alberta Health Services’ Provincial Emergency Medical Services Palliative and End-of-Life Care Assess, Treat and Refer Program. HEC and the Partnership worked closely with the original innovators to drive the adoption of this approach to teams in other areas of the country.
Read about the impact of the program from healthcare providers and families:
"Paramedics feel this is some of the most rewarding work they do, and patients and families describe the relief they feel being more able to remain home with the support of this new program."
Alix Carter, MD
Medical Director of Research at EHS Nova Scotia and member of the Paramedics Providing Palliative Care at Home Program team in Nova Scotia and Prince Edward Island (2019)
“I will be forever grateful for the Paramedics and Palliative Care program for the very diligent patient-centred way in which they were willing to accommodate my unique request because it enabled my father-in-law to get a good night’s sleep, it enabled me to do what I needed to do as a family member in providing comfort, and it enabled my mother-in-law to have the necessary medication... and it was as simple as a phone call.”
Family member, Newfoundland and Labrador
“Yes, we responded to this call for an Extra-Mural palliative patient; the family was concerned about their loved one who was having difficulty breathing. We were able to provide the patient some comfort with supplemental oxygen decreasing his accessory muscle use. It was nice as we were able to reassure the family, provide some help during this difficult time by answering some questions they had and also prepare them for some difficult decisions that they possibly may have to make.”
Paramedic, New Brunswick
“Patients often express their wish to have end of life care at home. They want to die peacefully in their own home surrounded by their loved ones. However, if they experience acute symptoms such as shortness of breath or delirium, their caregivers may panic and call 911. In the past, this has led to patients being transferred to the emergency room sometimes in the final hours or days of life. The paramedics and palliative care program allow paramedics to treat those acute symptom needs, avoid transfer to the hospital and ensure continuity of care with the community team. It is an example of interprofessional collaboration where the patient’s needs are at the centre. It allows the patient to get the right care, in the right place at the right time. Ultimately, it honours the patient’s wishes for a peaceful death at home.”
Palliative Care Physician, Ontario
“Caregivers hold their breath and hope an unexpected crisis won’t occur. But it does and it usually happens after hours on a weekend, or on a holiday. This is precisely when help is not easily accessible, but our experience tells us that if you call the paramedics, they will come. You aren’t waiting for a callback on the phone. Paramedics offer much needed reassurance and expertise in the face of an urgent situation.”
“I believe this program has provided the community with a positive avenue for end of life and comfort care. In allowing individuals and families 24-hour access to paramedics who are well trained in providing care/interventions for those experiencing crisis related to their disease, I believe we have saved our health care system, time, money, and resources by assisting these families within their homes. Allowing those who are ill autonomy in their treatment plans, who may otherwise feel they have lost control over their lives.”
Paramedic, Newfoundland and Labrador
“The paramedics were able to give several different medications to comfortably settle the patient. I had ordered for urgent delivery of a symptom relief kit but knew it wouldn't arrive until sometime the next morning. The paramedics had to go back at 7 a.m. the next morning to administer more meds. The patient died that next morning (before the symptom relief kit had even arrived). I feel like this patient would have likely ended up in the ER and died there if it had not been for the paramedics.”
Palliative Care Physician, Ontario
“I have never experienced similar gratitude displayed by patients and families as much as I have when supporting this population. It has really changed my mind and opened my eyes to the difference paramedics providing palliative care can make.”
“It left me with a good feeling being able to respect this patient’s wishes to be left at home and yet still be able to provide some care to keep her comfortable in her time of need. For myself, I felt connected to the patient and her family even having just met them. I left there feeling comforted by the fact that I was able to make a difference in this patient’s life.”
1 Canadian Institute for Health Information. Access to Palliative Care in Canada. Ottawa, ON: CIHI; 2018.
2 Canadian Institute for Health Information. Access to Palliative Care in Canada. Ottawa, ON: CIHI; 2018.
3 Carter AJE, Arab M, Harrison M et al. Paramedics Providing Palliative Care at Home: A Mixed-Methods Exploration of Patient and Family Satisfaction and Paramedic Comfort and Confidence. CJEM 2018 in press.