The Dying Patient: Palliative and End of Life Care: Part 3

In Part 3 of The Dying Patient: Palliative and End of Life Care, we delve into the complexities ambulance clinicians face when supporting patients in their final days and hours. Often the first to recognise when someone is dying, paramedics work within a system where community engagement may be limited, making their role crucial in identifying signs such as terminal agitation, unconsciousness, and other common symptoms. The episode discusses the importance of anticipatory medications and proactive advance care planning , especially in situations involving carer breakdown or when patients change their minds about where they wish to die.

We explore why ambulance services are frequently called during end-of-life stages, whether due to uncontrolled symptoms, sudden deterioration, or emotional distress within families. Paramedics not only offer symptom relief, both pharmacological and non-pharmacological, but also provide vital emotional support to those navigating grief, denial, or fear. Challenges include differentiating between reversible conditions and active dying, managing care when anticipatory medications are unavailable, and coordinating with wider healthcare teams.

Breaking bad news is another critical area discussed, with a focus on using frameworks such as Ask-Tell-Ask and adapting communication to the emotional needs of the moment. Lastly, the episode reflects on cultural considerations in a city as diverse as London. From language barriers and different expressions of grief to religious rituals and care after death, ambulance clinicians must remain adaptable and compassionate, ensuring that care is respectful, inclusive, and sensitive to the needs of every individual and their family. Some of the links to information mentioned in the episode can be found here: These are some of the resources mentioned in the episode:

• Breaking Bad News: ⁠⁠https://www.sth.nhs.uk/clientfiles/File/Breaking%20bad%20news%20Reflection%20on%20the%20process.pdf⁠⁠

• Good Grief - understanding the grief journey in more detail: ⁠⁠https://good-grief.org/resources/⁠⁠

• Hospice UK, an excellent place for further resources: ⁠⁠https://www.hospiceuk.org/our-campaigns/dying-matters/dying-matters-awareness-week
• UK National Guidelines on Diabetes and End of Life Care: .css-j9qmi7{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:row;-ms-flex-direction:row;flex-direction:row;font-weight:700;margin-bottom:1rem;margin-top:2.8rem;width:100%;-webkit-box-pack:start;-ms-flex-pack:start;-webkit-justify-content:start;justify-content:start;padding-left:5rem;}@media only screen and (max-width: 599px){.css-j9qmi7{padding-left:0;-webkit-box-pack:center;-ms-flex-pack:center;-webkit-justify-content:center;justify-content:center;}}.css-j9qmi7 svg{fill:#27292D;}.css-j9qmi7 .eagfbvw0{-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;color:#27292D;}