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Palliative care role planned for ambulance personnel

However, members of PHECC’s Medical Advisory Committee (MAC) have raised concerns about “service delivery and educational requirements” in relation to the introduction of the Palliative Care-Adult CPG for paramedics and advanced paramedics. These concerns were documented in minutes of the MAC’s meeting in May.

According to minutes of PHECC’s Council meeting in June, a “considerable amount of work” would be required by service providers to implement the CPG.

The Medical Independent (MI) understands that the HSE National Ambulance Service (NAS) and the HSE Clinical Programme in Palliative Care are developing a training package to support the introduction of the CPG.

A HSE spokesperson told MI: “The 2016 CPGs have not yet been formally published by PHECC. When they are published, NAS will review the CPGs in detail, assess how they can be best applied to patient care and devise an appropriate training package – this is the standard NAS approach to new iterations of CPGs.”

PHECC’s Deputy Director and Registrar Mr Barry O’Sullivan explained that sometimes an ambulance may be called by anxious family members when a patient has been discharged from hospital by a palliative care consultant for the purposes of dying at home.

He told MI: “Once that ambulance is called, the crew in the ambulance have no choice at the moment other than to take that patient in the ambulance back to the hospital that they have already been discharged from with full medications and the patient may die in the ambulance, may die in the A&E, behind a curtain, with one family member present, rather than their wish to die at home….We have drafted a clinical practice guideline that will allow practitioners not to transport the patient.”

In many cases families just need reassurance in relation to the dying process, he said. Implementation of the CPG would also free up ambulances as appropriate.

Under the CPG, ambulance personnel would consult the instructions from the palliative care consultant and hospital, verify that prescribed medications were being administered correctly, and give reassurance.

The CPG will be published by the end of this year.

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