Paramedics and Palliative Care: Bringing Vital Services to Canadians

Healthcare Excellence Canada (HEC) and the Canadian Partnership Against Cancer (the Partnership) partnered to deliver the Paramedics and Palliative Care program, bringing vital in-home palliative approaches to care to people in Canada living with cancer and other life-limiting conditions – when they need it and where they want it.

It's not uncommon for patients and families to call paramedic services when they experience sudden changes in care or gaps in accessing 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 approaches to 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. 2As 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.

How in-home palliative care contributes to better healthcare in Canada

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:

  • a decrease in the number of transports to hospital in both urban and rural areas
  • better symptom control and quality of life at home
  • up to an hour of paramedic time savings per call
  • improved paramedic comfort and confidence delivering palliative care

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.

How the partnership worked

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:

  • improving access to palliative approaches to care regardless of location and time of day
  • improving paramedic skills in providing palliative care
  • bridging support for patients, families and caregivers until their usual care team can take over
  • reducing avoidable emergency department visits and hospitalizations

This approach to palliative 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 spread this approach to other areas of the country.

"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)

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.

3Carter 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.