Improving palliative paramedicine

In Australia, like many countries, there is an increasing desire for people to die at home, surrounded by comfort and familiarity. Yet, despite palliative care being acknowledged as part of paramedicine, few jurisdictions have specific guidelines for paramedics to deliver this care effectively.

Furthermore, paramedics are often overstretched and under-resourced, making it difficult to meet the specific needs of those at the end of life.

As part of my PhD research, I focused on how we can improve this situation.

While my studies do not directly address people living with dementia who wish to die at home, it does consider how paramedicine can better support those who prefer to remain in their homes rather than be transferred to acute care settings.

This is particularly important for people with dementia, who often find the hospital environment disorienting and distressing.

Every participant agreed that paramedics could significantly enhance care

My recent study, Health professionals’ and caregivers’ perspectives on improving paramedics’ provision of palliative care in Australian communities: a qualitative study, sought to understand the views of health professionals working in palliative paramedicine, as well as general healthcare professionals and family carers on how to better support people living in the community who want to die at home.

Health professionals, bereaved family members, and carers were invited to participate if they were over 18 years of age and had been involved in the care of someone requiring palliative care who encountered paramedics at the end of life in a community setting.

We explored the growing potential for paramedics to play a more prominent role in delivering palliative and end-of-life care, especially during out-of-hours emergencies.

Every participant – whether a healthcare professional or family carer – agreed that paramedics could significantly enhance care for patients, families and healthcare teams.

And they also agreed that improving palliative paramedicine requires a multifaceted approach, focusing on systems, services, communities, and individuals to close current gaps in care and ensure better access to paramedics trained in palliative care.

Education and integration in existing health networks

One of the challenges we face is integrating palliative care into the core responsibilities of paramedics. Balancing their traditional emergency response duties with a more patient-centred palliative care role will require a significant shift.

To support this integration, we recommend embedding palliative and end-of-life care education into both undergraduate and postgraduate paramedicine programs. Additionally, paramedics’ skills must be better recognised within existing interdisciplinary palliative care networks.

Drawing inspiration from international models such as Canada’s Paramedics Providing Palliative Care at Home program, we’ve seen how successfully palliative care can be integrated into paramedic practice.

Collaboration between paramedics and specialist palliative care teams is essential, as perspectives on paramedics’ roles often differ between these groups.

Supporting the broader community

The study also highlights the importance of piloting palliative paramedicine programs in regional and remote areas.

These areas often face additional challenges in providing end-of-life care, and paramedics can play a critical role in supporting healthcare teams, reducing hospitalisations, and strengthening relationships across sectors.

By building these connections, we can improve continuity of care for patients nearing the end of life.

Ultimately, paramedics are uniquely positioned to identify and support patients in need of palliative care within the community. While not every paramedic will specialise in this area, all paramedics should be equipped with generalist palliative care skills.

Expanding the scope of paramedic practice and fostering collaboration with palliative care teams will ensure paramedics are better prepared to provide compassionate, high-quality care to patients and families.

Paramedics can enhance person-centred care

This research forms part of a larger study that offers a framework for future policies and practices in Australia and beyond, with the potential to standardise best practices and shape a more integrated approach to palliative paramedicine.

When adequately trained and supported, paramedics can enhance person-centred care, reduce avoidable hospitalisations, and help people fulfill their wish to die at home.

However, embedding palliative and end-of-life care into paramedics’ core responsibilities will require interventions at the structural, healthcare service, and individual clinician levels.

Key recommendations from our study include giving paramedics access to electronic medical records, maintaining paramedic-specific guidelines for end-of-life care, and ensuring they are connected to local palliative care pathways.

By doing so, we can empower paramedics to provide the compassionate care that so many patients and families need at the end of life, allowing more people to spend their final days where they feel most at peace – at home.

Dr Madeleine Juhrmann is a trained paramedic and a research fellow at Flinders University Research Centre for Palliative Care, Death and Dying

Dr Juhrmann’s research was supported by HammondCare Foundation and supervised by Professor Josephine Clayton, director of research and learning at the Palliative Centre at HammondCare

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