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Paramedics’ experiences of end of life care decisions

Paramedics and end of life care

With significant numbers of people in residential and nursing homes, paramedics face challenging situations when responding to emergency calls from patients in end of life situations.

The decision of the best course of action can often be complex and conveyance to the ED is often viewed as the best decision. This UK-based study explores the views of paramedics from the London Ambulance NHS Trust, interviewed to explore the decision-making process associated with transporting patients from nursing homes to EDs in end of life care situations.

The study identifies influences with direct impact on paramedics decision-making including difficulty understanding patients wishes, often as a result of inadequate documentation or because nursing home staff are simply unaware. This is made more challenging as many patients are unable to verbalise their own wishes.

Patient difficulties

Paramedics also expressed difficulty

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With significant numbers of people in residential and nursing homes, paramedics face challenging situations when responding to emergency calls from patients in end of life situations.

Paramedic at work
Paramedic at work. Picture: iStock

The decision of the best course of action can often be complex and conveyance to the ED is often viewed as the best decision. This UK-based study explores the views of paramedics from the London Ambulance NHS Trust, interviewed to explore the decision-making process associated with transporting patients from nursing homes to EDs in end of life care situations.

The study identifies influences with direct impact on paramedics’ decision-making including difficulty understanding patients’ wishes, often as a result of inadequate documentation or because nursing home staff are simply unaware. This is made more challenging as many patients are unable to verbalise their own wishes.

Patient difficulties

Paramedics also expressed difficulty in evaluating patients’ best interests, often trying to balance perceived risks and benefits of hospitalisation, while being influenced by nursing staff, carers and relatives. In these situations, decision-making becomes a process of negotiation between interested parties.

The study recognises the role of ambulance services in provision of end-of-life care, but concludes there is a need for paramedic training to avoid patients being transferred to EDs often in their last days of life, or against their wishes or interests. 


Murphy-Jones G, Timmons S (2016) Paramedics’ experiences of end-of-life care decision-making with regard to nursing home residents: an exploration of influential issues and factors. Journal of Emergency Medicine. doi:10.1136/emermed-2015-205405

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