Emergency medical services (EMS) clinicians increasingly encounter seriously ill patients and their caregivers in times of distress. When crises arise or care coordination falls short, these high-stakes interactions highlight opportunities to improve care experience and outcomes. Efforts must address wide educational gaps, absence of specialized care protocols, and systematic fragmentation leading to hyperlocal practice. The authors represent cross-sectional expertise in palliative care and EMS. This article describes unmet needs at the EMS-palliative interface, challenges with collaboration, and where directional progress exists.
Get full access to this article
View all access options for this article.
References
1.
WaldropD, ClemencyB, MaquinE, et al.Prehospital providers' perceptions of emergency calls near life's end. Am J Hosp Palliat Care, 2015; 32(2):198–204; doi: 10.1177/1049909113518962
2.
KrohmerJ. History of Emergency Medical Services. In: Emergency Medical Services: Clinical Practice and Systems Oversight, 3rd ed. (Cone D. ed.). Wiley; 2021; pp. 1–20.
AvegnoJ, ElderJM. Emergency Medical Services and Disaster Medicine. In: Emergency Medicine: Clinical Essentials, 2nd ed. (Adams JG. ed.). Elsevier Saunders; 2012; pp. 1774–1778.
7.
Department of Health Services. Los Angeles County. Policy Regarding Controlled Drugs Carried on ALS Units. Revised 4-01-2020. Available from: http://file.lacounty.gov/SDSInter/dhs/206303_702.pdf [Last accessed June7, 2022].
8.
PowellJR, BrowneLR, GuildK, et al.Evidence-based guidelines for prehospital pain management: Literature and methods. Prehosp Emerg Care, 2022; 1–8; In Press; doi: 10.1080/10903127.2021.2018074
AldridgeMD, EpsteinAJ, BrodyAA, et al.The impact of reported hospice preferred practices on hospital utilization at the end of life. Med Care, 2016; 54(7):657–663; doi: 10.1097/MLR.0000000000000534
11.
PhongtankuelV, PaustianS, ReidMC, et al.Events leading to hospital-related disenrollment of home hospice patients: A study of primary caregivers perspectives. J Palliat Med, 2017; 20(3):260–265; doi: 10.1089/jpm.2015.0550
LambaS, SchmidtTA, ChanGK, et al.Integrating palliative care in the out-of-hospital setting: Four things to jump-start an EMS-palliative care initiative. Prehosp Emerg Care, 2013; 17(4):511–520; doi: 10.3109/10903127.2013.811566
14.
StoneSC, AbbottJ, McClungCD, et al.Paramedic knowledge, attitudes, and training in end-of-life care. Prehosp Disaster Med, 2009; 24(6):529–534; doi: 10.1017/s1049023x00007469
15.
DonnellyCB, ArmstrongKA, PerkinsMM, et al.Emergency medical services provider experiences of hospice Care. Prehosp Emerg Care, 2017; 22(2):237–243; doi: 10.1080/10903127.2017.1358781
16.
WengerA, PotilechioM, RedingerK, et al.Care for a dying patient: EMS perspectives on caring for hospice patients.”. J Pain Symptom Manage, 2022; 64(2):e71–e76; doi: 10.1016/j.jpainsymman.2022.04.175
17.
SchmidtTA, ZiveD, FrommeEK, et al.Physician orders for life-sustaining treatment (POLST): Lessons learned from analysis of the Oregon POLST Registry. Resuscitation, 2014; 85(4):480–485; doi:10.1016/j.resuscitation.2013.11.027
18.
BreyreAM, VertelneyH, SporerKA, et al.Emergency medical service interpretation of Physician Orders for Life-Sustaining Treatment (POLST) in cardiopulmonary arrest. J Am Coll Emerg Physicians Open, 2022; 3(2):e12705; doi:10.1002/emp2.12705
19.
MirarchiFL, CammarataC, ZerkleSW, et al.TRIAD VII: Do prehospital providers understand physician orders for life-sustaining treatment documents?. J Patient Saf, 2015; 11(1): 9–17; doi: 10.1097/PTS.0000000000000164
20.
SchmidtTA, HickmanSE, TolleSW, et al.The Physician Orders for Life-Sustaining Treatment program: Oregon emergency medical technicians' practical experiences and attitudes. J Am Geriatr Soc, 2004; 52(9):1430–1434; doi:10.1111/j.1532-5415.2004.52403
21.
MillinMG, KhandkerSR, MalkiA. Termination of resuscitation of nontraumatic cardiopulmonary arrest: Resource document for the National Association of EMS Physicians position statement. Prehosp Emerg Care, 2011; 15(4):547–554; doi: 10.3109/10903127.2011.608872
22.
CamposA, ErnestEV, CashRE, et al.The association of death notification and related training with burnout among emergency medical services professionals. Prehosp Emerg Care, 2021; 25(4):539–548; doi: 10.1080/10903127.2020.1785599
23.
BreyreAM, BeneschT, GlombNW, et al.EMS experience caring and communicating with patients and families with a life-limiting-illness. Prehosp Emerg Care, 2022; 26(5):708–715; doi: 10.1080/10903127.2021.1994674
24.
HobgoodC, HarwardD, NewtonK, et al.The educational intervention “GRIEV_ING” improves the death notification skills of residents. Acad Emerg Med, 2005; 12(4):296–301; doi: 10.1197/j.aem.2004.12.008
25.
HansonK, KrampD. Hospice patient-focused emergency medical services protocols: An evaluation of emergency medical service protocols in the United States. J Pain Symptom Manage, 2022; 63(6):1098–1099; doi: 10.1016/j.jpainsymman.2022.04.069
26.
AusbandSC, MarchJA, BrownLH. National prevalence of palliative care protocols in emergency medical services. Prehosp Emerg Care, 2002; 6(1):36–41; doi: 10.1080/10903120290938751
ShoenbergerJ, LambaS, GoettR, et al.Development of hospice and palliative medicine knowledge and skills for Emergency Medicine Residents: Using the Accreditation Council for Graduate Medical Education Milestone Framework. AEM Educ Train, 2018; 2(2):130–145; doi: 10.1002/aet2.10088
30.
LoffredoT, ChanG, WangD, et al.United States best practice guidelines for primary palliative care in the emergency department. Ann Emerg Med, 2021; 78(5):658–669; doi: 10.1016/j.annemergmed.2021.05.021
31.
WangDH. Beyond code status: Palliative care begins in the emergency department. Ann Emerg Med, 2017; 69(4):437–443; doi: 10.1016/j.annemergmed.2016.10.027
32.
EMS Agenda 2050 Technical Expert Panel. EMS Agenda 2050: A People-Centered Vision for the Future of Emergency Medical Services (Report No. DOT HS 812 664). National Highway Traffic Safety Administration: Washington, DC, USA; 2019.
33.
Centers for Medicare & Medicaid Services. Emergency Triage, Treat, and Transport (ET3) Model. Available from: https://innovation.cms.gov/innovation-models/et3 [Last accessed: October 24, 2022].
34.
BreyreA, TaigmanM, SalvucciA, et al.Effect of a mobile integrated hospice healthcare program on emergency medical services transport to the Emergency Department. Prehosp Emerg Care, 2022; 26(3):364–369; doi: 10.1080/10903127.2021.1900474
35.
RamjitA. Hospice at Home: Paramedics as Part of the Team. Poster presentation at American Academy of Hospice and Palliative Medicine Annual Assembly; 2022.
HelmerJ, BaranowskiL, ArmourR, et al.Developing a paramedic approach to palliative emergencies. Progr Palliat Care, 2021; 29(2):72–75; doi: 10.1080/09699260.2020.1852656
38.
AntevyPM, ScheppkeKA, CardonaJ, et al.Reducing 9-1-1 System Over-Utilization Through a Targeted Community-Paramedic Hospice Referral Program. Poster presentation at National Academy of Emergency Medical Services Physicians Annual Meeting; 2018.
O'ConnorRE, ConeDC. If you've seen one EMS system, you've seen one EMS system. Acad Emerg Med, 2009; 16(12):1331–1332; doi: 10.1111/j.1553-2712.2009.00607.x
41.
ZiveDM, CookJ, YangC, et al.Implementation of a novel electronic health record-embedded physician orders for life-sustaining treatment system. J Med Syst. Nov, 2016; 40(11):245; doi: 10.1007/s10916-016-0605-3
42.
The Office of the National Coordinator for Health Information Technology. Electronic End-of-Life and Physician Orders for Life-Sustaining Treatment (POLST) Documentation Access through Health Information Exchange (HIE); July 2018. Available from: https://www.healthit.gov/sites/default/files/topiclanding/2018-07/POLSTRegistryKnowledge.pdf [Last accessed: October 24, 2022].
