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clinical practice

End-of-life care part 1: implications for paramedic practice

02 September 2020
Features
02 September 2020
Volume 12 · Issue 9

Abstract

Caring for patients who are approaching the end of life is an important part of the paramedic's role. Patients' circumstances are individual; for some, death is expected and may even a welcome (albeit sad) relief from a long period of pain and distress, while for others it is a tragic, unexpected outcome after every effort to prevent it has been exhausted. Regardless of circumstances, paramedics have to make wide-ranging clinical decisions, underpinned by a complex legal and regulatory framework. Paramedics generally have to obtain a patient's informed consent before proceeding with any intervention. They may be challenged if a dying patient refuses life-sustaining treatment or no longer has the mental capacity to consent and need to know the law on decision-making in these cases. This article discusses issues around capacity and consent at the end of life. The next article in this series considers issues such as advance decisions to refuse treatment and do not attempt CPR decisions.

After completing this module, the paramedic will be able to:

Recognising that a patient is dying or at risk of dying is intrinsic to the work of paramedics working in emergency or urgent care. They may get called to a trauma scene where it becomes apparent that casualties have life-threatening injuries, or arrive at the home of a patient with ‘breathing difficulties’ to discover that they are unresponsive, snoring and have a Glasgow Coma Scale (GCS) score of 3.

Paramedics may be called to a person's home by a distressed relative who has discovered that their loved one has taken an overdose of medication in attempt to end their life, or by a devastated parent who found their 3-year-old child face down in the paddling pool and has not been able to get them to respond. Or they may be called at 3 am by the partner of a 45-year-old woman receiving palliative care at home for breast cancer with brain and bone metastases, who is concerned because her breathing and level of consciousness have changed.

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