Original Research: Pain Management and Palliative Care

Integrating emergency medical services and palliative care: A nominal group technique

Caleb H. Gage, Liz Gwyther, Julia Ambler, Jan Burke, Katya Evans, Linley Holmes, René Krause, Kaleb Lachenicht, Danielle Lincoln, Kerene Payne, Mpho Ratshikana-Moloko, Charnelle Stander, Willem Stassen
African Journal of Primary Health Care & Family Medicine | Vol 17, No 1 | a4891 | DOI: https://doi.org/10.4102/phcfm.v17i1.4891 | © 2025 Caleb H. Gage, Liz Gwyther, Julia Ambler, Jan Burke, Katya Evans, Linley Holmes, René Krause, Kaleb Lachenicht, Danielle Lincoln, Kerene Payne, Mpho Ratshikana-Moloko, Charnelle Stander, Willem Stassen | This work is licensed under CC Attribution 4.0
Submitted: 16 January 2025 | Published: 24 June 2025

About the author(s)

Caleb H. Gage, Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Liz Gwyther, Division of Interdisciplinary Palliative Care and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Julia Ambler, Umduduzi-Hospice Care for Children, Durban, South Africa; and, Department of Paediatrics, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and, Department of Family Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Jan Burke, Netcare911, Johannesburg, South Africa
Katya Evans, Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Department of Health, Mitchells Plain District Hospital, Cape Town, South Africa
Linley Holmes, Division of Interdisciplinary Palliative Care and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
René Krause, Division of Interdisciplinary Palliative Care and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Department of Health, Groote Schuur Hospital, Cape Town, South Africa
Kaleb Lachenicht, Rocket Helicopter Emergency Medical Service, Johannesburg, South Africa
Danielle Lincoln, Hospice, University of the Witwatersrand, Johannesburg, South Africa
Kerene Payne, Chariot Health, Cape Town, South Africa
Mpho Ratshikana-Moloko, Department of Health, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; and, Centre for Palliative Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Soweto Comprehensive Cancer Centre, Johannesburg, South Africa
Charnelle Stander, Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Willem Stassen, Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

Abstract

Background: The need for integrated healthcare has been increasingly recognised because of mounting challenges associated with the proliferation of injuries and noncommunicable diseases. A developing example of integration is between Emergency Medical Services (EMS) and palliative care. Despite recommendations for integration in South Africa (SA), these services remain segregated.

Aim: This study aimed to develop and prioritise approaches facilitating EMS and palliative care system integration within SA.

Setting: An online meeting was held with SA EMS and palliative care experts.

Methods: A nominal group technique was employed to answer the question, ‘What do you think should be done to most effectively integrate EMS and palliative care services in SA?’ Answers were categorised, awarded scores by participants, and ranked according to impact and feasibility.

Results: The following categories were generated: Awareness, Education, Community Engagement, Communication and Information Sharing, Stakeholder Collaborations, Alternative Pathways and Approaches, Research, Funding, Policy Development and Governance. The top five individual approaches were: (1) enable EMS to administer already prescribed medications, (2) Emergency Medical Services undergraduate training in palliative care, (3) improve EMS recognition of signs of dying at the end-of-life, (4) palliative care awareness for the EMS community, and (5) palliative care awareness for in-hospital healthcare providers, particularly those in emergency medicine.

Conclusion: The categories developed in this study should be used to guide EMS and palliative care integration in SA. Future research should aim at establishing the safety and efficacy of these interventions.

Contribution: This study provides a structured approach to integrating EMS and palliative care in SA, enhancing holistic care for patients with palliative needs.


Keywords

paramedic; ambulance; EMS; palliative care; end-of-life; person-centred care; healthcare system integration; South Africa.

Sustainable Development Goal

Goal 3: Good health and well-being

Metrics

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Total article views: 318


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