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Impact of paramedics carrying just-in-case end-of-life care medication

02 November 2023
Volume 15 · Issue 11



Early in the COVID-19 pandemic, it was predicted that frail community patients with symptoms of severe COVID-19 infection may need urgent symptom management—and that unless they had already been identified as being in their last weeks of life, they would be unlikely to have just-in-case (JIC) medications at home. The Welsh Ambulance Services NHS Trust therefore placed JIC medications on emergency ambulances to increase symptom management options for paramedics treating patients with symptoms of severe COVID-19 infection and/or associated with advanced end-stage illness.


A review of medications to palliate symptoms of severe COVID-19 infection and advanced and terminal illness was undertaken. A verbal order process was implemented, allowing prescription-only medications to be administered by paramedics. Guidance, training and data capture processes were designed and implemented.


Symptoms associated with advanced cancer were the main reason for giving ambulance-based JIC medications, and midazolam and morphine were the most administered medicines. No adverse incidents were reported or recorded.


Ambulance-based JIC medications were and continue to be appropriately administered, irrespective of life-limiting illness diagnosis. Although carrying JIC medicines on ambulances was introduced in response to the COVID-19 pandemic, 12 months of data collection indicates this is a safe, cost-effective, patient-centred practice.

With an ageing population and consequent rise in adult mortality, the need for health and social care services to provide high quality, integrated end-of-life care (EoLC) is ever increasing (Age UK, 2019).

While 70% of people at the end of life (EoL) were reported to prefer to die at home given the right support (Department of Health and Social Care, 2008), the individual patient's decision-making with respect to their preferred place of death is complex and often changes during their disease trajectory (Hoare et al, 2015). Given these complexities, it is important that all health professionals involved in caring for patients at the EoL have the necessary skills to facilitate patients achieving their preferred place of death. Appropriate management of pain, anxiety and other symptoms should therefore be a crucial goal, shared by patients, their family and carers as well as health professionals (Bowers et al, 2019).

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