Abstract
Background:
Paramedics commonly face acute crises of patients in palliative care, but their involvement in end-of-life care is not planned systematically.
Aim:
To evaluate a protocol for end-of-life care at home including pre-planned integration of paramedics and end-of-life care wards.
Design:
Paramedic visits to patients in end-of-life care protocol were retrospectively studied.
Setting/Participants:
All of the patients who had registered for the protocol between 1 March 2015 and 28 February 2017 in North Karelia, Finland, were included in this study.
Results:
A total of 256 patients were registered for the protocol and 306 visits by paramedic were needed. A need for symptom control (38%) and transportation (29%) were the most common reasons for a visit. Paramedics visited 43% and 70% of the patients in areas with and without 24/7 palliative home care services, respectively (p < 0.001); while 58% of all the visits were done outside of office hours. Problems were resolved at home in 31% of the visits. The patient was transferred to a pre-planned end-of-life care ward and to an emergency department in 48% and 16% of the cases, respectively. More patients died in end-of-life care wards in areas without (54%) than with (33%) 24/7 home care services (p = 0.001).
Conclusions:
Integration of paramedics into end-of-life care at home is reasonable especially in rural areas without 24/7 palliative care services and outside of office hours. The majority of patients can be managed at home or with the help of an end-of-life care ward without an emergency visit.
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