In the course of your career, you will come across Palliative care emergencies. In most of the episodes we are looking at where it might be less appropriate to take patients to hospital and keeping patients at home is the appropriate and essential decision for all concerned.

In certain cases, the family and patient may be urging you to keep them at home but there are instances where it is more appropriate to take them to hospital as you may well be adding life to days when days cannot be added to life.

We look at:

• JR Calc metastatic spinal cord compression
• Neutropenic sepsis
• Catastrophic bleeds
• Superior venacava compression
• Hypercalcaemia

Rob Whelan Paramedic

A paramedic since 2012 and working as a community specialist paramedic for 3 years. Rob has a particular interest in lower acuity care and developing alternatives to transport pathways. He is the NWAS lead for virtual frailty wards in Cheshire and Merseyside and has worked with urgent community response teams across CAM to improve care for older people.

Kieran Potts Paramedic

Kieran qualified as a Paramedic in 2011 and has held roles within the clinical leadership structure, and research and development team of North -West Ambulance Service. Kieran currently holds a clinical leadership role as a Community Specialist Paramedic and holds the portfolio for Regional Palliative and End of Life Care leadership, having undertaken an Advanced Clinical Practice MSc with modules focused on palliative and end of life care.

We are joined by Ed O’Brian in the Welsh Ambulance Service who discusses the inspiring innovations that he has developed and introduced to better support patients that access the ambulance service at the end of life. These include introducing just in case medications onto ambulances to help ensure better symptom control, the introduction of an end-of-life care rapid transport service to convey dying patients to their preferred place of death, a wish ambulance service to help dying patients experience a meaningful journey, and the introduction of the UKs first palliative care paramedics.

Edward O’Brian is a Macmillan paramedic and clinical lead for palliative and end of life care in the Welsh Ambulance Services NHS Trust (WAST).

Ed has master’s degree in palliative medicine and he co-chairs the National Ambulance End of Life Care Leads Group, working with clinical leads across the UK in the development of guidelines specific to ambulance led end of life care. His publication is here(PDF) Impact of paramedics carrying just-in-case end-of-life care medication (researchgate.net)

In many cases information such as DNACPR is not there, and information needs to be gathered in a short space of time and a decision made in the moment. We cover in this episode:

• Natural Dying v DNACPR
• EPACC explained
• ACP
• What to do in the absence of any source of information
• Case Studies

Rob Whelan Paramedic

A paramedic since 2012 and working as a community specialist paramedic for 3 years. Rob has a particular interest in lower acuity care and developing alternatives to transport pathways. He is the NWAS lead for virtual frailty wards in Cheshire and Merseyside, and has worked with urgent community response teams across CAM to improve care for older people.

Kieran Potts Paramedic

Kieran qualified as a Paramedic in 2011 and has held roles within the clinical leadership structure, and research and development team of North -West Ambulance Service. Kieran currently holds a clinical leadership role as a Community Specialist Paramedic and holds the portfolio for Regional Palliative and End of Life Care leadership, having undertaken an Advanced Clinical Practice MSc with modules focused on palliative and end of life care.