Palliative Care Education for Paramedic Students and Paramedics

Tania Blackmore, Senior Lecturer in Adult Nursing (Palliative care) at the University of Greenwich has developed a course for both qualified paramedics and paramedic students in palliative care.

Background
Paramedics are often the clinicians who have the most contact with palliative patients and are vital to improve the quality of care for this patient group. Paramedics often voice their frustration at not receiving enough training and education in the principles of palliative care. The available research supports the need for palliative care education for paramedics; Taghavi et al‘s (2011) research found that paramedics did not feel that they had adequate education in palliative and end of life care (EoLC) and stated the need for guidelines. According to Brady (2014) there is a lack of any specific reference to End of Life Care (EoLC) in the QAA Benchmarks for Paramedic Science (2004) and the Joint Royal Colleges Ambulance Liaison Committee (JRCALC 2013) shows little mention of palliative or EoLC guidelines. An added challenge to paramedics is not only the need to understand EoLC, but to also recognise the main reversible palliative care emergencies (Watson et al, 2009), which are:

  • Sepsis in the neutropenic patient
  • Metastatic Spinal Cord Compression
  • Super Vena Cava Obstruction
    Hypercalceamia

Untreated palliative care emergencies can lead to premature death or seriously decrease the quality of life of patients (Schrijivers, 2010).

Good Practice
Since joining the University of Greenwich in 2014, Tania, who is an experienced Clinical Nurse Specialist in palliative care in the community, has worked with paramedic colleagues to ensure that palliative care education is incorporated into the pre-registration paramedic curriculum. To increase knowledge of palliative care needs, paramedics are taught the principles of palliative and end of life care in their first, second and third years using a ‘framework of assessment for palliative care patients,’ developed at the University of Greenwich.

In addition to the framework, paramedic students at the University of Greenwich also learn about the following:

  1. The Principles of Palliative Care (symptom control)
  2. Palliative Care Emergencies,
  3. End of life care
  4. Bereavement, loss and professional resilience
  5. The dying phase of the disease trajectory
  6. Ethical issues of palliative care

Tania also leads workshops for registered paramedics employed by South East Coast Ambulance Service which run several times during the year. The workshops introduce the principles of Palliative and End of Life Care and have received excellent feedback.

Wiese et al (2013) in an international study of prehospital palliative care consisting of a 150 leading experts in palliative and emergency care in Europe, North and South America, Africa, Asia and Australia found that 92% of the questioned experts recommended that palliative education should be incorporated into emergency curriculum training. By adding Palliative Care Education throughout the pre-registration palliative care curriculum and engaging with the ambulance service the University of Greenwich is adding to the professional resilience and knowledge of future paramedics and, more vitally, improving outcomes for palliative patients in the community which include achieving:

  1. Preferred Place of Care
  2. Better symptom control
  3. Avoiding unnecessary hospital admissions at end of life

Feedback so far from colleagues and students in Tania’s efforts to improve palliative care education for acute clinicians has been very positive.