Integration of paramedic services into end-of-life care at home: From pilot trial to everyday practice


Each month, Professor Catherine Walshe, Editor-in-Chief of Palliative Medicine, chooses an article that readers may find particularly interesting or useful and invites the authors to draw out the key points on the EAPC blog. Focusing on research that is novel, a robust review, from a specific country or just slightly left of field, the ‘Editor’s Choice’ post aims to share experience and stimulate ideas. We hope you’ll read the longer article in ‘Palliative Medicine’ – EAPC members can access a FREE copy from the EAPC website.

Today, Leena Surakka and Minna M Peake, Palliative Care Center, Siun SOTE – North Karelia Social and Health Services Joint Authority, Joensuu, Finland, give the background to their longer article selected as ‘Editor’s Choice, in the March 2021 issue of ‘Palliative Medicine’.

 Minna M Peake (left) and Leena Surakka. 

We are delighted that our article, ‘Preplanned Participation of Paramedics in End-of-life Care at Home: A retrospective cohort study’, was selected as ‘Editor’s choice’.

When discussing with our patients at palliative outpatient clinic, we ask where they would like to spend the last days of their lives. Usually they reply: “at home”. Home is a place where we can be ourselves – with our own customs and timetables and surrounded by the people we love.

In Finland, the implementation of end-of-life care at home is often done in cooperation with healthcare professionals from the hospital at home service or different home care teams supported by palliative care professionals. Availability and operating hours of these services vary in different parts of the country creating unfortunate gaps in services, especially in rural areas. This has led to situations where the patients and their caregivers may end up calling for help from the emergency number in case of acute crisis outside of office hours. A combination of legal regulations, normal operating models of emergency services that aim to save lives, and a lack of knowledge about a patient’s choice of treatment, result in paramedics transferring patients at the end of life to the emergency department of the hospital. Unfortunately, it is then quite common that patients with rapidly deteriorating health end up by having unnecessary investigations that won’t improve their health but will potentially add to their suffering. Typically, these patients also die at the hospital despite their wish to stay at home for the last days of their lives.

Understanding the operating models of emergency services led to the development of an end-of-life care protocol for paramedics in the local palliative care project called Paletti (2013–2015). The protocol aimed to develop ways of integrating paramedic services into the care of end-of-life patients at home, so that any problems experienced by patients could be solved at home by highly trained paramedics, or by transferring patients to preplanned end-of-life care wards, instead of the emergency department. The protocol was developed in cooperation with North Karelia paramedic services in eastern Finland and was approved to be used by the local hospital district authorities within the municipality. As the use of this protocol differed from the usual operating model of emergency services, we first needed approval from the department responsible for paramedic services within the Finnish Ministry of Health and Social Affairs. A trial of the end-of-life care at home protocol for paramedics started in March 2015; it continued for several months and is now a well-established part of everyday service for paramedics in North Karelia. Use of this protocol has expanded the scope of practice for paramedics and it has also given them new tools and confidence to meet the care needs of end-of-life care patients. The protocol has been further developed, integrating paramedic services into an earlier phase of palliative care in special circumstances.

Based on our research results and experience gained from the use of the end-of-life care protocol for paramedics, we feel strongly that all healthcare professionals involved in the care of end-of-life patients should work in close collaboration with palliative care professionals, and have basic knowledge of how to respond to the care needs of end-of-life patients. This requires clearly written advance care plans and good communication between all healthcare professionals involved in patient care.

We hope that the findings of this study will encourage reflection on the role of paramedic services as part of implementing and supporting end-of-life care at home.

This post relates to the longer article, ‘Preplanned Participation of Paramedics in End-of-life Care at Home: A retrospective cohort study’ by Leena K Surakka, Minna M Peake, Minna M Kiljunen,  Pekka Mäntyselkä and Juho T Lehto, published in Palliative Medicine Volume: 35 issue: 3, page(s):584-591. Article first published online: December 18, 2020; Issue published: 1 March 2021.

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This entry was posted in EAPC-LINKED JOURNALS, Palliative Medicine: Editor's Choice, RESEARCH and tagged . Bookmark the permalink.

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