Paramedics and Palliative Care 

  • Forming Teams
  • Planning Initiative
  • Launch
  • Changes Tested
  • Some Improvement
  • Improvement
  • Significant Improvement
  • Sustainable Improvement

It is not uncommon for patients and families to experience sudden changes in care and/or gaps in access to needed resources and as a result, call on paramedic services for support. Traditional emergency medical service response is based on principles of assessing, treating and transporting patients to the emergency department. The result of calling 911 may be a rapid response, but through a system of care that is not designed to meet the needs and wishes of patients requiring palliative care. 

The Canadian Foundation for Healthcare Improvement and the Canadian Partnership Against Cancer (the Partnership) have partnered to deliver the Paramedics and Palliative Care program, bringing vital in-home palliative care to Canadians living with cancer and other life-limiting conditions – when they need it and where they want it.

As part of this four-year $5.5 million collaboration, more than 5,000 paramedics across seven provincial teams will be trained to provide patients with in-home support when they have a palliative emergency, require pain and symptom management and/or have an unexpected health event.

This approach to palliative care was identified through an open call for innovations in 2017 as the Paramedics Providing Palliative Care at Home Program in Nova Scotia and Prince Edward Island, and Alberta Health Services’ Provincial Emergency Medical Services Palliative and End-of-Life Care Assess, Treat and Refer Program. CFHI and the Partnership worked closely with the original innovators to spread this approach to other areas of the country.

How Paramedics in Palliative Care contributes to better healthcare in Canada

Of those living in Canada who have a preference, 75 percent indicate they would prefer to die in their home. However, this doesn’t happen as often as it could. Sixty-two percent of people living in Canada who receive palliative care do so in an acute care hospital and often in their last month of life.1

Evidence shows paramedics providing palliative and end-of-life care in the home improves the comfort and quality of life for people living with life-limiting illnesses, as well as their families and caregivers.2

Through the program, paramedics are trained to assess people with palliative care needs (for example, pain management) and treat them on the spot at home. Paramedics are trained to provide this care without a transfer to hospital, if appropriate. Paramedic services are using a variety of training approaches and supports including LEAP (Learning Essential Approaches to Palliative Care) which is provided by Pallium Canada and developed by Canadian Virtual Hospice.  

The program is contributing to: improving access to palliative care support regardless of location and time of day; improving paramedic skills in providing palliative care; bridging support for patients, families and caregivers until their usual care team can take over; and reducing avoidable emergency department visits and hospitalizations.

Evaluation is embedded throughout this program with each of the participating teams submitting quantitative and qualitative data on the use and impact of palliative care services provided by paramedics in the home. Results from the program’s first year will be shared in 2020. Subscribe to our newsletter to check out the results when they are available.

The Approach

CFHI and the Partnership are supporting participating provincial health authorities and organizations to adopt and adapt best practices in palliative care training. The teams participating in the program are working with their community partners to design programs that include three main components:

  1. Knowledge and skill development in palliative care
  2. Supporting and leveraging the use of a centralized database for communication and identification of patients with palliative care needs
  3. Planning and patient management including screening symptoms, and linking paramedics to emergency physicians, palliative care clinicians (e.g. palliative care nurse) and/or to home care organizations and providers.

The Teams 

  • Paramedics and Palliative Care Teams

Paramedics feel this is some of the most rewarding work they do, and patients and families describe the relief they feel being more able to remain home with the support of this new program.

-Dr. Alix Carter
Medical Director of Research at EHS Nova Scotia andmember of the Paramedics Providing Palliative Care at Home Program team in Nova Scotiaand Prince Edward Island (2019)