Reframing Emergency Medical Service in the context of chronic non-communicable disease and palliative care

Abstract

Background: Emergency Medical Service (EMS) is often the initial primary contact for patients with non-communicable disease (NCD) with symptom exacerbation. EMS personnel are not trained to manage patients requiring this type of care, or recognise the need for palliative care or expert consultation.
Aim: To describe how EMS’ are often responsible for managing patients with NCDs and symptom exacerbation and to assess whether palliative care and support by EMS in the out-of-hospital sector should be considered.
Setting: The study took place in the southern peninsula of Cape Town, including urban, suburban and rural communities, including the informal housing community.
Methods: This was a retrospective descriptive analysis of de-identified patient report forms of adult patients (over 18 years old) attended to by a private EMS between January 2019 and April 2019. The patients included in the research met the inclusion criteria, identifying them as possibly requiring palliative care assistance because of the symptom exacerbation of their NCDs.
Results: Of the 283 patients many had more than one NCD, and more than one of the primary symptoms of pain, shortness of breath, cognitive changes, nausea and vomiting simultaneously. The majority of these patients were likely to go to the hospital with ambulance transport, and frequently, there was no appropriate clinical intervention by paramedics. Clinical advice was seldom sought by paramedics for patients with symptom exacerbation related to their NCDs, with the data indicating that palliative care access for patients was minimal.
Conclusion: Palliative care is a necessary approach to patient-centred care, with EMS being an available resource to assist with this approach. There is a necessity for improved communication and support between palliative care resources and EMS to mitigate inappropriate transport of these patients to already over-burdened emergency departments, and to improve home care by EMS.
Contribution: This study highlights the need for appropriate palliative care support by EMS for patients with chronic disease and symptom exacerbation.