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Paramedics and Palliative Care: Bringing Vital Services to Canadians

Healthcare Excellence Canada (HEC) and the Canadian Partnership Against Cancer (the Partnership) partnered to deliver the Paramedics and Palliative Care program, bringing vital in-home palliative approaches to care to people in Canada living with cancer and other life-limiting conditions – when they need it and where they want it.

Elderly masked-patient laying on a couch with a masked-healthcare worker holding her left hand. The healthcare worker is resting her right hand on the patient's forehead.
Topics
  • Long-term care
  • Aging in place
  • Primary and community care
Audience
  • Healthcare leader

  • Point of care provider

  • Quality or safety improvement lead

Paramedics and Palliative Care: Bringing Vital Services to Canadians

Healthcare Excellence Canada (HEC) and the Canadian Partnership Against Cancer (the Partnership) partnered to deliver the Paramedics and Palliative Care program, bringing vital in-home palliative approaches to care to people in Canada living with cancer and other life-limiting conditions – when they need it and where they want it.

About the Program

It's not uncommon for patients and families to call paramedic services when they experience sudden changes in care or gaps in accessing home care services and supports. While traditional emergency medical service response is based on assessing, treating and transporting patients to the hospital, it’s not designed to meet the needs and wishes of patients requiring palliative treatment options for care.

This matters because three-quarters of people indicate they would prefer to die in their home.1 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.2 As part of this program’s four-year collaboration, more than 7,500 paramedics and 200 additional healthcare providers across seven provincial teams were trained to provide patients with in-home support when they have a palliative emergency, require pain and symptom management or have an unexpected health event.

  • Canadian Partnership Against Cancer

The Partnership

Through the program, paramedics were 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, MyGriefToolbox.ca developed by Canadian Virtual Hospice, and other education developed by teams as part of the program. 

Participating teams received:

  • Seed funding to support implementation

  • Tailored learning opportunities through webinars and coaching calls

  • Opportunities to share, learn and problem-solve with peers

  • Support to measure and evaluate the success of their project

Teams engaged patient and family/caregiver advisors to ensure that the program met their needs. Patient and family/caregiver advisors also helped develop evaluation tools, such as patient and family surveys, to help measure the impact of the program and inform ongoing improvements.

This approach to person-centred 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. HEC and the Partnership worked closely with the original innovators to drive the adoption of this approach to teams in other areas of the country.

  • Canadian Virtual Hospice
  • Pallium Canada

Paramedics and Palliative Care: Bringing Vital Services to Canadians Change Package

The Paramedics and Palliative Care: Bringing Vital Services to Canadians change package provides core principles and elements required to develop and implement a palliative approach to care for paramedic services. It brings together the experiences and learnings from 10 teams across nine provinces and territories who have successfully implemented this approach to home care services.

The change package includes examples of how teams participating in the Paramedics and Palliative Care program  implemented a palliative approach to care for paramedics in their jurisdiction. It also includes tips from program coaches and project team members, and recommendations for engaging patients, family members and essential care partners.

STANDARD BUTTON - PDF (6 MB)

Teams

Ten teams across nine provinces participated in the Paramedics Providing Palliative Care: Bringing Vital Services to Canadians program.

The original innovator sites in Nova Scotia, Prince Edward Island and Alberta formed three of the teams. They participated as coaching jurisdictions and worked with HEC and the Partnership to spread and scale the Paramedics and Palliative care program to other areas of Canada.

Newfoundland and Labrador, New Brunswick, Ontario, Manitoba, Saskatchewan, and British Columbia participated as implementation teams. They were supported to successfully implement the program.

Participating and coaching jurisdictions located on a map of Canada. British Columbia Emergency Health Services is in Vancouver, British Columbia. It is a participating jurisdiction. Alberta Health Services Emergency Medical Services and Alberta Health is shown in Calgary, Alberta. It is a coaching jurisdiction. Saskatchewan Health Authority, Regina Area is in Regina, Saskatchewan. It is a participating jurisdiction. Interlake-Eastern Regional Health Authority is shown in Winnipeg, Manitoba. It is a participating jurisdiction. York Region Paramedic Services is in the Regional Municipality of York, Ontario. It is a participating jurisdiction. The Ottawa Hospital Research Institute is shown in Ottawa, Ontario. It is a participating jurisdiction. Ambulance New Brunswick/Extra Mural Program is in Moncton, New Brunswick. It is a participating jurisdiction. Nova Scotia Emergency Health Services and Nova Scotia Health Authority is a coaching team. It is shown in Halifax, Nova Scotia. Island Emergency Medical Services and Health PEI is another coaching jurisdiction. On the map it is shown in Charlottetown, Prince Edward Island. Finally, is the participating jurisdiction of Eastern Health. It is in St John’s, Newfoundland and Labrador.

Advisors

The Paramedics and Palliative Care: Bringing Vital Services to Canadians program was supported by several advisors, subject matter experts, patient and family advisors and coaches. Advisors shared their experiences either as individuals and families who had lived experiences of receiving palliative care, or as professionals who had expertise in palliative approaches to care as well as healthcare improvement. For a full list of contributors, see the Paramedics and Palliative Care change package.

Paramedics and Palliative Care Program Outcomes

The Paramedics and Palliative Care program equipped paramedics and other healthcare providers to provide appropriate, patient-centred palliative care closer to home and community, resulting in improved efficiencies in the healthcare system.

How Paramedics and Palliative Care contributed to better healthcare in Canada

Decreased transports to hospital in both rural and urban areas

  • 52.8 percent of calls enabled people receiving palliative care to remain in their homes, diverting patients from the emergency department

Improved access to patient-centred care closer to home and community

  • Almost 7,000 calls were received from people wishing to access palliative care in their homes

  • Over 92 percent of surveyed patients and families were satisfied with the care they received by paramedics and 86.6 percent of calls improved the presenting complaint

Improved efficiency in the healthcare system

  • An average of 31 minutes were saved per call by treating palliative patients at home compared with transporting them to the emergency department

Improved comfort and confidence for paramedic team members delivering palliative care

  • 71.3 percent of paramedics felt more comfortable and confident providing palliative care

  • More than 7,500 paramedics and 200 additional healthcare providers were trained to support palliative patients at home

  • "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."

  • “I will be forever grateful for the Paramedics and Palliative Care program for the very diligent patient-centred way in which they were willing to accommodate my unique request because it enabled my father-in-law to get a good night’s sleep, it enabled me to do what I needed to do as a family member in providing comfort, and it enabled my mother-in-law to have the necessary medication... and it was as simple as a phone call.”

  • “Yes, we responded to this call for an Extra-Mural palliative patient; the family was concerned about their loved one who was having difficulty breathing. We were able to provide the patient some comfort with supplemental oxygen decreasing his accessory muscle use. It was nice as we were able to reassure the family, provide some help during this difficult time by answering some questions they had and also prepare them for some difficult decisions that they possibly may have to make.”

  • “Patients often express their wish to have end of life care at home. They want to die peacefully in their own home surrounded by their loved ones. However, if they experience acute symptoms such as shortness of breath or delirium, their caregivers may panic and call 911. In the past, this has led to patients being transferred to the emergency room sometimes in the final hours or days of life. The paramedics and palliative care program allow paramedics to treat those acute symptom needs, avoid transfer to the hospital and ensure continuity of care with the community team. It is an example of interprofessional collaboration where the patient’s needs are at the centre. It allows the patient to get the right care, in the right place at the right time. Ultimately, it honours the patient’s wishes for a peaceful death at home.”

    Suggested Citation

    These outcomes are informed by data collected by HEC, the Partnership, and the seven teams in six provinces, representing 31 paramedic services, that participated in the program. When citing this information, we ask that you use the following reference:

    • Healthcare Excellence Canada, the Canadian Partnership Against Cancer, and Paramedics and Palliative Care teams. How Paramedics and Palliative Care contributed to better healthcare in Canada. August 2023.

    • “I have never experienced similar gratitude displayed by patients and families as much as I have when supporting this population. It has really changed my mind and opened my eyes to the difference paramedics providing palliative care can make.”

    • “The paramedics were able to give several different medications to comfortably settle the patient.  I had ordered for urgent delivery of a symptom relief kit but knew it wouldn't arrive until sometime the next morning. The paramedics had to go back at 7 a.m. the next morning to administer more meds.  The patient died that next morning (before the symptom relief kit had even arrived).  I feel like this patient would have likely ended up in the ER and died there if it had not been for the paramedics.”

    • “It left me with a good feeling being able to respect this patient’s wishes to be left at home and yet still be able to provide some care to keep her comfortable in her time of need. For myself, I felt connected to the patient and her family even having just met them. I left there feeling comforted by the fact that I was able to make a difference in this patient’s life.”

    • “Caregivers hold their breath and hope an unexpected crisis won’t occur. But it does and it usually happens after hours on a weekend, or on a holiday. This is precisely when help is not easily accessible, but our experience tells us that if you call the paramedics, they will come. You aren’t waiting for a callback on the phone. Paramedics offer much needed reassurance and expertise in the face of an urgent situation.”

    • “I believe this program has provided the community with a positive avenue for end of life and comfort care. In allowing individuals and families 24-hour access to paramedics who are well trained in providing care/interventions for those experiencing crisis related to their disease, I believe we have saved our health care system, time, money, and resources by assisting these families within their homes. Allowing those who are ill autonomy in their treatment plans, who may otherwise feel they have lost control over their lives.” 

      Resources

      The resources below are from organizations that participated in the Paramedics and Palliative Care: Bringing Vital Services to Canadians program, including teams, coaches, Healthcare Excellence Canada and the Canadian Partnership Against Cancer.

      1 Canadian Institute for Health Information. Access to Palliative Care in Canada. Ottawa, ON: CIHI; 2018.

      2 Canadian Institute for Health Information. Access to Palliative Care in Canada. Ottawa, ON: CIHI; 2018.

      3 Carter AJE, Arab M, Harrison M et al. Paramedics Providing Palliative Care at Home: A Mixed-Methods Exploration of Patient and Family Satisfaction and Paramedic Comfort and Confidence. CJEM 2018 in press.

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