Relieving suffering and supporting the patient and the family: end-of-life care guidance for paramedics.

We’re delighted to present this month’s ‘Editor’s Choice’ from Palliative Medicine, the official research journal of the EAPC. This month, Leena Surakka and Kari Törrönen tells us about the findings of their research into end-of-life protocols for paramedics in Finland…and why they could benefit patient care and experience.

two people standing by an ambulance
Kari Törrönen and Dr.Leena Surakka.

In 2013 we understood that there is an urgent need to develop the end of life care provided by North Karelia Emergency Medical Services in Finland. We inspected together some stories of the patients who received care at home at the end of their lives and realised that the emergency medical service guidelines and protocols do not serve the needs of these patients.

There are three main stages in the traditional care procedure in emergency medical services. First, assessment. Secondly, treatment based on patient´s symptoms and finally, as it is vital to find out the cause of symptoms for emergency care, paramedics usually transfer the patient to the emergency department. Yet for patients already identified as being near the end-of-life, these stages may not be in their best interests or what they wish – for example, it could more comfortable to give high quality palliative care in their home or transfer the patient to preplanned end-of-life care ward when necessary.

Due to this, we decided to create a new protocol for the needs of end-of-life care patients in North Karelia. This protocol isn’t an instruction manual with rigid rules, but rather guidance which helps us incorporate the patient’s advance care planning and wishes. It differs a lot from normal emergency medical protocols which concentrates on keeping patient alive in all circumstances. The main goal of care in end-of-life care protocol is to relieve suffering and support the patient and the family. By using the protocol, paramedics are able to relieve, for example, pain and shortness of breath effectively. It is important that the protocol allows certain medicines, such as fentanyl, to be used differently than usual (such as administered through the nose, not just intravenously or subcutaneously). 

High quality end-of-life care is based on advance care planning. An individually made care plan must have been made with patients and their relatives and then be available for everyone in the end-of-life care team, including paramedics. The end-of-life care protocol for paramedics clearly clarifies the goals of this care.  Our research found that 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. However, paramedics expressed challenges in psychosocial aspects, communication, symptom management, and their role in end-of-life care. For example, encountering the patient and family might be stressful and cause negative feelings. The death of end-of-life care patient can get ’under the skin’, especially when the caring relationship is long. Supporting the family in their grief may be a burden. As a response, North Karelia rescue department has developed a ’defusing’ system to support paramedics, consisting, for example, of clinical supervision and using the help of specifically trained counsellors. The purpose is that nobody is left alone with these difficult feelings, and the support is available for the carers as well.

Where are we now? In the beginning, nurses of the palliative home care team informed Emergency Medical Services when the patient was transferred to end-of-life care at home.  Nowadays the end-of-life care status stays in the electrical medical record, which is also available for paramedics to view. This allows paramedics to check individual care plans when with a patient.

End-of-life care protocol was implemented in 2015 in North Karelia, Finland. Since then it has become a vital part of Emergency Medical Services operations in the area. All new employees receive training on the protocol, and even the most experienced paramedics wish to have continual training of the issue. We are confident of benefits for patients, their carers and palliative emergency medical services. Kari adds:

‘I have always been interested in starting new practices and I like to co-operate and work together with other colleagues. Hence, creating end-of life care protocol for North Karelia EMS was interesting and satisfying project for me. Now we can make sure that end-of-life care patients receive the best and individually planned care when needed.’


We hope you’ll read the longer article in ‘Palliative Medicine’ – EAPC members can access a FREE copy from the EAPC website. ’Paramedics’ experiences and educational needs when participating end-of-life care at home: A mixed method study.’ Leena K Surakka, Minna Hökkä, Kari Törrönen, Pekka Mäntyselkä and Juho T Lehto. First published: Palliative Medicine 2022, Volume 36 (8):1217-1227.

Links and resources

  • A previous blog on this subject from Leena Surakka and Minna Peake was one of our most read blogs from 2021! Click here to read it.

About the authors

Leena Surakka is a chief physician in Siun Sote Palliative Care Center, Finland. Previously she worked as a General Practioner (GP) in Joensuu’s Home Hospital in 2010-17. Orcid no: 0000-0002-6444-0158

Kari Törrönen has been working in emergency services since 1988. He is a trained nurse and paramedic, and he also has professional teacher´s degree and a Masters in healthcare. He is currently Department Chief of Emergency Medical Services in the Fire and Rescue Department of Siun Sote North Karelia Social and Health Services Joint Authority.

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This entry was posted in ADVANCE CARE PLANNING, EAPC-LINKED JOURNALS, Palliative Medicine: Editor's Choice, PATIENT & FAMILY CARE and tagged . Bookmark the permalink.

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