Nausea, breathlessness, agitation and pain are common symptoms that people suffer near the end of end-of-life, whether they have cancer, heart failure, COPD or another terminal illness.
These symptoms can be intense, often compelling people or their family caregivers to call 911 for paramedics’ aid. The typical protocol for paramedics has been to assess and stabilize patients, then transfer them to hospital—but the stress of an ambulance ride and time in emergency is not usually the best thing for patients in these situations.
“We realized that paramedics were being called upon to assist in symptom crises, but that they didn’t have the training, protocols or tools to help people on the ground, in their homes, without taking them to hospital,” notes BRIC NS member, Dr. Alix Carter, an emergency physician at the QEII Health Sciences Centre, faculty member at Dalhousie Medical School and medical director of research at EHS Nova Scotia. “This prompted us to look at how we could better prepare paramedics to provide more advanced care in the home.”
Working with stakeholders in primary, palliative and emergency care, Dr. Carter’s team worked with Pallium Canada to develop a training course to teach paramedics the essentials of providing palliative and end-of-life care in the field. Now that this program has been in place across Nova Scotia since 2015, Dr. Carter and her colleagues are evaluating its impact and helping collaborators in British Columbia determine how such a program could be modified for rollout there.
Dr. Alix Carter is leading a BRIC NS project evaluating paramedics’ role in providing palliative care in the home.
“We’re assessing key benchmarks of quality care—such as number of people transported to emergency, or who die at home—to see how we’re doing now compared to before the service started,” she says, explaining that she and her team are interviewing paramedics who’ve taken part in the training, and surveying patients and families who’ve received their care. “Does the new training enable paramedics to provide care that helps more people stay, and die, in their homes? Does it help patients and families better manage symptoms at home?”
With help from BRIC NS, Dr. Carter and her co-investigators were able secure a Canadian Institutes of Health Research (CIHR) Comparative Program and Policy Analysis grant, building on and complementing work funded by the Canadian Partnership Against Cancer, Nova Scotia Health Authority Research Fund, and NSHA TRIC (Transforming Research Into Care) funding.
“All projects that go through BRIC NS require involvement from a second province,” Dr. Carter says. “It’s exciting to work with British Columbia, to see how our approach can be adapted to address similar challenges they’re facing there. It’s an implementation science project, to evaluate the implications and what resources would be required.”
Dr. Carter and her colleagues are receiving national attention for their work to expand the role of paramedics in home-based palliative care. “We’re sharing our findings with home care chief executives across Canada and presenting at the National Health Care Leadership Conference in Vancouver in June,” she says. “Our research shows that families feel very positively about their experiences with the specially trained paramedics, and paramedics felt well prepared to play this role. There are some bugs to work out but we see this as a viable solution to a problem that has an enormous physical, practical and emotional impact on people at a very vulnerable time.”