In the course of your career, you will come across Palliative care emergencies. In most of the episodes we are looking at where it might be less appropriate to take patients to hospital and keeping patients at home is the appropriate and essential decision for all concerned.

In certain cases, the family and patient may be urging you to keep them at home but there are instances where it is more appropriate to take them to hospital as you may well be adding life to days when days cannot be added to life.

We look at:

• JR Calc metastatic spinal cord compression
• Neutropenic sepsis
• Catastrophic bleeds
• Superior venacava compression
• Hypercalcaemia

Rob Whelan Paramedic

A paramedic since 2012 and working as a community specialist paramedic for 3 years. Rob has a particular interest in lower acuity care and developing alternatives to transport pathways. He is the NWAS lead for virtual frailty wards in Cheshire and Merseyside and has worked with urgent community response teams across CAM to improve care for older people.

Kieran Potts Paramedic

Kieran qualified as a Paramedic in 2011 and has held roles within the clinical leadership structure, and research and development team of North -West Ambulance Service. Kieran currently holds a clinical leadership role as a Community Specialist Paramedic and holds the portfolio for Regional Palliative and End of Life Care leadership, having undertaken an Advanced Clinical Practice MSc with modules focused on palliative and end of life care.

We are joined by Ed O’Brian in the Welsh Ambulance Service who discusses the inspiring innovations that he has developed and introduced to better support patients that access the ambulance service at the end of life. These include introducing just in case medications onto ambulances to help ensure better symptom control, the introduction of an end-of-life care rapid transport service to convey dying patients to their preferred place of death, a wish ambulance service to help dying patients experience a meaningful journey, and the introduction of the UKs first palliative care paramedics.

Edward O’Brian is a Macmillan paramedic and clinical lead for palliative and end of life care in the Welsh Ambulance Services NHS Trust (WAST).

Ed has master’s degree in palliative medicine and he co-chairs the National Ambulance End of Life Care Leads Group, working with clinical leads across the UK in the development of guidelines specific to ambulance led end of life care. His publication is here(PDF) Impact of paramedics carrying just-in-case end-of-life care medication (researchgate.net)

Our Hosts Mary Buttle and Tess Taylor lead a hugely insightful podcast on the concept of Total Pain, sharing through their extensive experience examples of different types of pain and how vital it is in caring for the whole person.

Mary Buttle

A Clinical Nurse Specialist with an extensive career in Oncology and Palliative and End of Life Care. Mary attained a Honours degree in adult palliative and end of life care and has been delivering education and training in this speciality for over 6 years. Previously an Education Lead at the End-of-Life Partnership, delivering training to Paramedics from Northwest Ambulance Service

Theresa Taylor, Practice Education End of Life Partnership

Works as a practice educator for the End-of-Life Partnership based in Crewe. A registered nurse by background, Tess worked in palliative and end of life care as a specialist nurse and educator for over 20 years. She attained a degree in Palliative Care , an MSc in Pain Management, and has a huge passion for supporting paramedics through education. She feels privileged to be able to do this through the End of Life Care Training for North West Ambulance Service and through teaching paramedics at Stafford University.

In many cases information such as DNACPR is not there, and information needs to be gathered in a short space of time and a decision made in the moment. We cover in this episode:

• Natural Dying v DNACPR
• EPACC explained
• ACP
• What to do in the absence of any source of information
• Case Studies

Rob Whelan Paramedic

A paramedic since 2012 and working as a community specialist paramedic for 3 years. Rob has a particular interest in lower acuity care and developing alternatives to transport pathways. He is the NWAS lead for virtual frailty wards in Cheshire and Merseyside, and has worked with urgent community response teams across CAM to improve care for older people.

Kieran Potts Paramedic

Kieran qualified as a Paramedic in 2011 and has held roles within the clinical leadership structure, and research and development team of North -West Ambulance Service. Kieran currently holds a clinical leadership role as a Community Specialist Paramedic and holds the portfolio for Regional Palliative and End of Life Care leadership, having undertaken an Advanced Clinical Practice MSc with modules focused on palliative and end of life care.

Through Karen Groves expert guidance we explore how vital communication skills are and the key aspects that make communication effective in often pressured situations. These include:

• Taking your time
• Asking the right questions

Dr Karen Groves Education Lead for Queenscourt Hospice

After 12 years in full time GP practice in a busy town centre in Southport, Merseyside, Dr Karen Groves was Medical & Education Director of Queenscourt Hospice, Southport and an NHS Consultant in Palliative Medicine working across hospital and community in integrated specialist palliative care services in West Lancs, Southport & Formby for 27 years. Having semi-retired, she is now Education Lead for Queenscourt Hospice and Honorary Clinical Professor, Edge Hill University delivering a Masters programme in Integrated Palliative & End of Life Care.

Episode 1 looks at the difference between palliative and end of life care. We are looking to understand what the aims of End of Life care are, and how there is a different mindset required from paramedics in this role.

We are joined by

Dr Kathryn Gaunt

A Consultant in Palliative Medicine at East Cheshire NHS Trust. She works across all clinical settings within East Cheshire, acute hospital, community, and hospice. This allows for a greater understanding of the challenges and developments happening across the healthcare arena. She is the Chair of the East Cheshire PLACE based Palliative and End of Life Locality Group where the focus is on steering the strategic direction of palliative and eol service delivery within the locality. She has a keen interest in palliative and End of Life education and developing and delivering simulation training within this area.

Dan Platt, Paramedic is currently working as a newly qualified paramedic within his second year of practice with Northwest Ambulance Service in the Merseyside area. Prior to this he spent 3 years completing his degree in paramedic science at Liverpool John Moores University, predominantly working around North Liverpool and the surrounding areas. Whilst studying at university Dan took on the role of CPD and Training Officer for the LJMU Paramedic Society, helping to facilitate numerous training events relating to end-of-life care in the paramedic role. During his time completing placements throughout university and leading into his career as a registered paramedic he regularly encounters patients who are nearing the end stages of their life, often proving to be one of the most challenging yet highly rewarding incidents they attend to.