The “palliative care ambulance” – making a difference to ‘out of hours’ palliative care
An article written by Associate Professor Aileen Collier
As the need for home-based palliative care continues to grow so too does the need for out-of-hours care. The resources of both specialist and generalist palliative care services are often focused towards business hours. At the same time, the response to the ever-increasing pressure on acute hospital beds is to shift care away from emergency departments and onto community services. Health and social care services struggle to keep pace. And clinical tasks previously the domain of health care professionals are transferred to family caregivers. Homes are often turned into ‘hospital’ as models of care shift away from the acute setting.  At the same time, the community and social care workforce faces significant pressure. For example, Australia is expected to have a nursing workforce shortage of 85,000 nurses by 2025. 
Until recently paramedics were often thought of as providers of life-saving and curative care. As an increasing number of older people experience chronic illness with associated fluctuating and uncertain, decisions about care and treatment paramedics are faced with situations that are not black and white.
As a result, the paramedic’s role in palliative care is becoming increasingly recognised.
South Australia Ambulance Service (SAAS) Extended care paramedics (ECPs) are Intensive care paramedics who have completed specialised intensive training, including skills enhancement and placement in palliative care. We wanted to find out the patient and family caregiver perspectives of ECPs because there is not a lot of research on how paramedics contribute to palliative care from the point of view of patients and families.
Our study found that Extended Care Paramedics were not only ‘Extended’ in terms of their paramedic role but that family caregivers saw them as an extension of the palliative care team. Family caregivers expressed how important it was for them to have a timely yet skilled and person-centred response to their immediate needs and concerns. Knowing ECPs were ‘there’ for them meant that they felt supported especially in unpredictable situations. Paramedics are highly skilled at dealing with unpredictable and uncertain situations. As a mobile and highly responsive workforce, paramedics are well placed to deliver out of hours unscheduled palliative care.  An important consideration in our study is that the SAAS ECPs had strong partnerships with local specialist palliative care services. They now have considerable experience and expertise in the field and receive additional education in palliative care making them well-placed to support family caregivers supporting a person with palliative care needs.
- Collier A, Phillips JL, Iedema R. The meaning of home at the end of life: A video-reflexive ethnography study. Palliat Med. 2015 Sep;29(8):695-702. doi: 10.1177/0269216315575677. Epub 2015 Mar 24.
- Health Workforce Australia. Australia’s Future Health Workforce – Nurses Detailed report [1.10MB pdf). 2014 Aug
- Long D. Paramedic delivery of community-based palliative care: an overlooked resource? Prog Palliat Care. 2019;27(6):289-290. doi: 10.1080/09699260.2019.1672414. Epub 2019 Oct 27.
You can read more about our study here: https://journals.sagepub.com/doi/full/10.1177/02692163231166760
Watch this short video to hear directly from participants Grant, his wife Michelle, and his son Thomas: https://www.youtube.com/watch?v=JPy2PtMTVQg&feature=youtu.be
We thank all participants for sharing their experiences.
A/Prof Aileen Collier
Associate Professor of Palliative Care and Aged Care Nursing
Research Centre for Palliative Care Death and Dying &
Northern Adelaide Local Health Network