The Welsh Ambulance Services NHS Trust (WAST) are increasingly called to palliative care patients at a point of sudden deterioration or crisis. The responding paramedic will not know the patient or have access to medical records prior to their arrival, therefore any assistance with information gathering on arrival is extremely useful. Unfortunately the majority of Advance Care Plans (ACPs) that may be found on scene do not always give the information that would be useful at the point of 999 response. WAST has therefore begun to produce its own ACPs for patients that are either likely to require 999 call (through being contacted by other agencies) or for patients that are picked up as frequent callers from 999 call records. These tailored ACPs contain information for the responding paramedic that includes: the patients’ medical condition(s), how advanced their condition is and what they would and would not want in the event of deterioration. They also detail specific actions on treatment for likely symptoms, for example if the patient presents with symptom A, consider approach or medication 1, in the event of further deterioration consider approach/medication 2 (for instance to help nausea, or pain or breathlessness).
The patient may have clearly recorded that they would not want hospital admission in certain circumstances, even if their life is at risk. Although only a small amount of these plans have so far been produced, feedback from patients, paramedics and professionals working with the patient has been very promising and unwanted admissions have been avoided as a result. Welsh ambulance paramedics have also received Serious Illness Conversation Cymru training (see Velindre NHS Trust and End of Life Care Board projects) in order to demonstrate that there is more to the work of a paramedic than interventional care and admission to acute sector; paramedics can be key to helping provide reassurance and comfort care, and should be a key part of the wider healthcare team that provides the option for palliative care patients to remain at home, in comfort or link up with hospice services.