Paramedics as providers of end-of-life care in the community

April 28 2021

Emergency ambulance responses are often associated with life-saving actions. However, paramedics also provide urgent and after-hours support to those with known life-limiting illness and their caregivers. They also attend sudden deaths, which may be due to unexpected or unknown causes. Relatively little is known about paramedic care of the dying, deceased and bereaved. A recently-published special issue of Progress in Palliative Care focuses on paramedic care at the end of life. It includes an article by Te Arai members, highlighting paramedic care of the dying, deceased and bereaved in Aotearoa, New Zealand.

Paramedics play an essential and distinct role as providers of care to the dying, deceased and bereaved in Aotearoa, New Zealand and around the world. Paramedics provide urgent and after-hours support to those with known life-limiting illness and their caregivers, but also attend sudden deaths, from unexpected or unknown causes.

Paramedic care at the end of life may present unique demands including:

• Attempted resuscitation

• Uncontrolled or public settings

• Adverse environmental conditions

• Challenging decision-making

• Challenging communication

• Multiple patients

• Limited information

• Complex or severe symptoms

• Recognition of irreversible dying

• Breaking bad news

• Managing the scene of a death

• Verifying death

• Supporting bystanders

• Reassuring co-responders

• Caring for the bereaved

There is an insufficient acknowledgement of the critical and unique role of paramedics, as providers of urgent and out-of-hours care to the dying deceased and bereaved. Ambulance personnel around the world want better preparation and support for end-of-life care. Future research should aim to evaluate and improve this vital care, explore the needs and experiences of those who call an ambulance in the context of death, dying or bereavement and address equity and cultural responsiveness.