A definition of End of life care is when a patient who is near the end of their life and the treatment that they were receiving to control the disease has been stopped. End of life care goal is to make the patient pain free and control any other symptoms that they may be experiencing (Curie, 2018). According to statistics 46.9 percent of end of life patients died in hospital in 2016 in England and only 21.8 percent dying in the comfort of their own home. When comparing the 2015 statistics there was only a 5.1 percent increase in patients passing away at home (Public Health England, 2018).
Evidence has suggested that over fifty percent of end of life patients in England would prefer to die at home, statistics confirms that patients are not being enabled and supported in their final days. Families can carry significant burdens supporting their relative during the final stage of their life, Evidence has shown that relatives of patients that die in hospital are more likely to receive Post traumatic Stress Disorder (PTSD) due to the experience of seeing their relatives hooked up to medical equipment.
The experience of undertaking a Paramedic science (BSC) degree and being placed within an Ambulance Service NHS Trust for my clinical placements has uncovered the lack of training and exposure that trainee clinicians receive regarding end of life care. It is important to explore this area and analyse these papers to see if there are any advances that the paramedic can do to advance in End of Life Care which will improve the care end of life patients receive and enable a `good death`.
A search was conducted using the Boolean method on databases. MEDLINE, PubMed this was accessed through the Anglia University website. Alternative words and synonyms were usedto search for articles, an inclusion/exclusion criterion was set (Table 2). These limitations helped to filter and exclude papers from inappropriate sources. Sources from magazines and guidelines are not considered reliable forms as guidelines have gaps in evidence. The standard rule searching papers is that paper should be no older than ten years old, the search was set between the years of 2009 to 2019.
To analyse the papers the Critical Appraisal Skills Programme (CASP) will be deployed to systematically assess the trustworthiness and reliability of the papers . Systematic reviews with a well determined methodology are regarded as strong evidence according to the hierarchy of evidence. Six themes suggest that there are various factors in how end of life care is managed in the pre-hospital setting. Paramedics have stated that these include Training, Access to Pathways, Best Interests for the patient, Decision making and Advanced care planning and documentation.
In conclusion end of life care is not effectively managed in the prehospital setting. Paramedics have not received sufficient training in end of life care to be able to effectively manage a dying patient at home. The support that Paramedics have access to out of hours is very limited which forces the Paramedic to convey the patient to hospital even though it may not be in the patient’s best interest.
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