PALLIATIVE SUPPORT BY EMERGENCY MEDICAL SERVICES FOR PERSONS AT THE END OF LIFE: A POPULATION BASED ANALYSIS OF NEED

Abstract

Emergency Medical Services (EMS) are often involved in providing care to individuals at the end of life. Despite this, the development of EMS palliative support has been limited. This thesis utilized a linked administrative database describing Nova Scotia decedents between 1995 and 2009, and EMS patient care records (PCRs) from January to March 2014 to describe the need for EMS palliative support and determine if EMS patient demographics differ between end of life and non-end of life related calls. In-hospital death rates were found to be high, supporting the need for improved home based care. Palliative care services (PCS) enrollment increased over study duration for both cancer and non-cancer decedents. Comorbidities were found to be common among individuals at the end of life. Overall, individuals with non-cancer conditions appeared to be more complex, and were enrolled in PCS less often and later than cancer decedents. EMS PCRs suggested that EMS is frequently involved in providing care to older adults and individuals with conditions that may benefit from palliative support. EMS providers did not often record advanced directives (ADs) and do not resuscitate orders (DNRs) on scene. The development and application of a Palliative Support Composite Measure (PSCM) to estimate the frequency of calls where palliative support may have been beneficial suggested 1% of EMS calls had a probable palliative purpose. A further 22.5% of calls were categorized as potential palliative, 45.6% were low potential palliative, while 30.9% of calls were categorized as non-palliative. The further refinement and validation of this measure is recommended. To address the limitations of this thesis, it is proposed that EMS and death certificate data be linked to further describe EMS utilization in the final year of life. As well, it is hoped that this linkage will help validate and refine the PSCM via Classification and Regression Tree (CART) analysis. EMS palliative support has the potential to address a gap in the delivery of out-of-hospital palliative care, as there are few options available in emergency situations. Improved emergency palliative support appears to be warranted as there is an increasing trend in the frequency of individuals requesting palliative care and wishing to receive care in the home. Considerations in the delivery of EMS palliative support include comorbidities at the end of life, the limited frequency of AD/DNRs, and the increasing prevalence of individuals with non-cancer conditions requesting palliative care.