Changing the system with Paramedics and Palliative Care

May 27, 2022

Changing the system with Paramedics and Palliative Care

By Alix Carter  

It’s spring in Nova Scotia and I’ve been spending time in the yard doing chores that come with any new season. It’s a lot of work but I don’t mind because it brings great change.  And my yard isn’t the only thing going through a metamorphosis – the work I’ve been doing with the Paramedics and Palliative Care program is entering a new season too. 

The Paramedics and Palliative Care program 

The Paramedics and Palliative Care program, a partnership between Healthcare Excellence Canada (HEC) and the Canadian Partnership Against Cancer, brings vital in-home palliative care to people  with cancer and other life-limiting conditions. This national collaborative spans over 6,000 paramedics, seven innovation teams and three coaching sites, providing patients and caregivers with in-home support when they have a crisis (i.e. increased need for pain and symptom management, unexpected health events.) 

Before this program, paramedics had few choices when responding to calls for palliative patients’ care: take them to hospital or get them to sign off on the risks of choosing to stay home, even though home is often where they wanted to be in their last weeks or days of life.  

This practice was jarringly incongruent with the sensitive moment, but there was no alternative. This program changed that for patients and families, providers and health systems from coast to coast by providing paramedics with the skills and resources for supporting people to pass away at home. 

Now after four years, the collaborative is releasing a Change Package – information, resources and tools - for those interested in taking a similar approach in their jurisdiction or area of care.  

At this milestone for the program, I’m reflecting on my experiences as an emergency medical services (EMS) physician and researcher involved from the outset.  

The journey: Starting with the needs of patients and paramedics  

My journey with paramedics and palliative care started in 2010, when I met with local palliative care researchers in Nova Scotia to talk about how our EMS/paramedic services data could add to their work. We realized paramedics were doing a fair amount of palliative care for people living at home and that EMS protocols were not designed for it. 

This is where we saw the opportunity for change. We collected evidence to confirm our instinct that paramedics could and should be part of palliative care by scoping the requirements of a key part of palliative care: advanced directives. 

We developed consensus among paramedics, emergency department physicians and nurses on what they needed. We also brought technology together with frontline providers and policymakers to plan for getting paramedics access to these directives.   

Our findings showed there was a need and paramedics could meet it. We built local partnerships between our paramedic service and palliative care programs, with strong backing by key stakeholders in health leadership. We then partnered with the Canadian Partnership Against Cancer. This was the beginning of the Paramedics and Palliative Care program in Nova Scotia and Prince Edward Island.   

After a few research papers and conferences, we linked up with a like-minded team from Alberta and the Canadian Foundation for Healthcare Improvement (now HEC). This was when our program was ready to spread! 

The national spread collaborative was launched with HEC and the Canadian Partnership Against Cancer. Innovation sites and teams were selected from across the country in six provinces and my colleagues and I had the privilege of coaching and mentoring them using the first-hand knowledge we’d gained to drive adoption of the program. 

The impact: Improved palliative paramedicine, for everyone 

Four years later, and I believe this program meets all the components of the quadruple aim. It’s made paramedic palliative care better for providers, patients, families and healthcare systems. It’s improved equity of access to palliative care, especially for rural and isolated populations. And best of all: it came from a real need and acted on what paramedics were asking for – to be equipped to provide better care. 

The stories we’ve heard about patients being able to die comfortably at home have moved us to tears and shown us that the program works.  

The feedback from paramedics has also been powerful. They’ve told us that the program is an incredible advancement for the profession that has changed the way people see paramedics – and the way paramedics see themselves. We’ve heard how the program has given them the tools needed to improve the quality of care that’s more suited to patients’ needs and situations.  

We’ve always believed paramedics bring a unique skill set that’s a significant value-add to the healthcare team. This program leveraged these existing skills by giving paramedics additional information and infrastructure. For example, paramedics already carried pain medications needed for palliative care. The only thing that changed was how and when they gave them to patients.  

Paramedics have an incredible ability to walk into a situation they don’t know, with people they’ve never met, and establish rapport with them in just a few minutes. This skill has been crucial to providing the calm and organization needed to manage crises for those receiving palliative care at home. 

This program also had broader effects on the healthcare system and pushed people to think more about system integration. We have seen the benefits of sharing information and working together to care for people, especially at an individual patient level. For me, this is the epitome of better care.  

The future: Entering a new era with the Change Package 

When I think back to where this all started – an unassuming meeting about data – I’m in awe of where we are today.  

We identified an innovation, spread and scaled it with the right partnerships, and now we’re releasing a change package that will help others benefit from this expanded paramedic services model.  

We started in Nova Scotia but didn’t end there. The learning and resources from this program will benefit anyone who wants to expand their paramedic services model. And that’s a great thing for paramedics, patients and families across Canada. 


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