Preplanned participation of paramedics in end-of-life care at home: A retrospective cohort study.

Abstract

Paramedics commonly face acute crises of patients in palliative care, but their involvement in end-of-life care is not planned systematically. To evaluate a protocol for end-of-life care at home including pre-planned integration of paramedics and end-of-life care wards. Paramedic visits to patients in end-of-life care protocol were retrospectively studied. 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. 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 (<i>p</i> < 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 (<i>p</i> = 0.001). 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.