Paramedics could soon help people die at home instead of in hospital in an aim to honour patients’ wishes and ease pressure on emergency departments

Ambulance officers could soon be empowered to play a bigger role in palliative care that aims to honour patients’ wishes.

Paramedics would be specially-trained to help people die at home instead of in hospital as part of a proposed overhaul to palliative care that aims to honour patients’ wishes and ease pressure on overstretched emergency departments.

Under the plan, developed as part of a study led by Flinders University research fellow and trained paramedic Dr Madeleine Juhrmann, ambulance officers would be empowered to play a bigger role in palliative care.

The SA Ambulance Service is considering the proposal.

At present, paramedics can only assist in home-based palliative care in certain circumstances, and otherwise have to transport patients to hospital.

There’s a new plan for paramedics to do more to help palliative patients die peacefully at home. Picture: Supplied

However, their responsibilities would be expanded under the mooted framework by providing paramedics with access to electronic medical records to see advance care directives and palliative care details in real time.

The plan would also ensure ambulance officers had the ability to administer specific subcutaneous medications for end-of-life symptoms without needing to be transported to hospital.

It would further seek to connect paramedics with alternative local palliative care services to expand transport options beyond emergency departments.

The plan was created in consultation with paramedics, palliative care doctors, GPs and carers and is supported by aged care provider HammondCare.

The framework has been published in leading international journal Palliative Medicine.

Dr Juhrmann said there was rising demand for home-based deaths, particularly in light of the Covid-19 pandemic.

“Many palliative care patients have expressed a clear wish to die at home with family and don’t want to be transported to hospital in an ambulance following straightforward pain management by a paramedic,” she said.

Leonie Jamieson was pleased that her husband was able to die peacefully at their Port Noarlunga home after receiving palliative care support from paramedics. - Leonie Jamieson and husband Neil. Picture: Supplied

Dr Juhrmann said paramedics already played a role in providing unscheduled palliative care to patients in community-based settings however this could vary greatly and needed more support.

“When adequately trained and supported, paramedics can enhance person-centred care, reduce avoidable hospitalisations and facilitate one’s preferred place of death,” she said.

An SA Ambulance spokesperson said while the organisation’s primary focus was on emergencies, it understood the need to support GPs and specialist palliative services in delivering care to patients in their homes.

“We are continually reviewing our Clinical Practice Guidelines to improve our support in this area and will be assessing all our guidelines against the framework to identify any opportunities for improvement,” they said.

The spokesperson said SAAS also recently mandated training for all paramedics in managing palliative emergencies.

Port Noarlunga resident Leonie Jamieson was thankful her husband Neil was able to pass away peacefully from mesothelioma at their home in 2019 after receiving palliative care support from paramedics.

Ms Jamieson said paramedics respected her husband’s wishes not to be intubated and taken to hospital.

“I had to get the (advance care directive) form, which paramedics read through very thoroughly and then said, ‘yep, we completely understand’,” she said.

They then “explained to me how to make Neil more comfortable,” Ms Jamieson said.