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B.C. paramedics learning to treat palliative patients at home, avoiding trips to ER

Click to play video: 'Paramedics being trained to help keep palliative care patients at home' Paramedics being trained to help keep palliative care patients at home
BC Emergency Health Services is training paramedics to help keep palliative care patients at home. The ASTaR palliative clinical pathway gives more options to those responding to emergency calls. As Kristen Robinson reports, it has been providing comfort for those receiving care. – Apr 15, 2022

Thousands of British Columbia paramedics have now been trained in a new care model that aims to keep palliative patients out of hospital as long as possible.

“We were transporting patients to hospital, often when they were towards end of life, and the environment wasn’t appropriate for the (physical state) they were in,” said Leon Baranowski, director of clinical and professional practice with BC Emergency Health Services.

Read more: Group opposes forced transfer of B.C. patients seeking medically-assisted deaths

That began to change three years ago as BC EHS developed the ASTaR initiative, which stands for assess, see, treat and refer, and which gives paramedics the tools to treat palliative patients at home in many cases.

It’s a major shift for a system when taking someone who called 911 to hospital was often the only choice for paramedics.

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The new model was initially introduced in five communities, Prince George, Nanaimo, Kamloops, the North Shore and Abbotsford. It has now been expanded provincewide.

“It was a wholesale change to the system. We started at the way the 911 call enters, our dispatch centres with our emergency medical call-takers, they get flagged for awareness and triage by our paramedic specialists, then we decide which vehicles to dispatch to the call,” Baranowski said.

Read more: Hamilton paramedics join provincial pilot to offer more options for 911 palliative care calls

Advocates and caregivers for people at the end of life have welcomed the option to avoid a disruptive, stressful and potentially painful transport to an emergency room.

“They made things a lot better,” said Gennifer Ryan, whose husband Jim recently passed away from lung cancer.

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Like many palliative patients, Ryan’s husband decided he wanted to stay at home as long as possible, but in December, he took a turn for the worst, requiring Ryan to call 911 for help.

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Under the program, paramedics were deployed to the home and were able to provide assistance without taking him to hospital.

“They were able to get my husband stabilized, get me calm and get him out of pain,” she said. “It made the world of difference to us. It kept my husband calm.”

Read more: Central Ontario paramedics can direct 911 palliative calls to care other than ER in pilot project

More than 1,300 paramedics have received specialized training under the program, due to funding through the Canadian Partnership Against Cancer and the Canadian Foundation for Healthcare Excellence.

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Patients have access to options including referral to other services or treatment in locations more suitable than the ER.

Kevin Harter, a board member with the B.C. Hospice Palliative Care Association calls the program “a very positive move.”

“It (helps) greatly (with) stress. It greatly supports the caregiver. As you can well imagine at this time of their life it’s important that their wants, their needs and their desires be respected and reflected in the service they receive,” he said.

“Many people want to experience end of life in the comfort of their home. This is a program that helps them achieve that goal, and supports the caregiver in supporting their loved ones achieve that goal.”

Since the program launched in 2019, more than 400 calls to 911 have met the ASTaR guidelines, allowing them to receive treatment from paramedics and stay in their homes.

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