• Leena K Surakka, Minna M Peake, Minna M Kiljunen, Pekka Mäntyselkä, and Juho T Lehto.
• Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
• Palliat Med. 2021 Mar 1; 35 (3): 584-591.

BackgroundParamedics commonly face acute crises of patients in palliative care, but their involvement in end-of-life care is not planned systematically.AimTo evaluate a protocol for end-of-life care at home including pre-planned integration of paramedics and end-of-life care wards.DesignParamedic visits to patients in end-of-life care protocol were retrospectively studied.Setting/ParticipantsAll of the patients who had registered for the protocol between 1 March 2015 and 28 February 2017 in North Karelia, Finland, were included in this study.ResultsA total of 256 patients were registered for the protocol and 306 visits by paramedic were needed. A need for symptom control (38%) and transportation (29%) were the most common reasons for a visit. Paramedics visited 43% and 70% of the patients in areas with and without 24/7 palliative home care services, respectively (p < 0.001); while 58% of all the visits were done outside of office hours. Problems were resolved at home in 31% of the visits. The patient was transferred to a pre-planned end-of-life care ward and to an emergency department in 48% and 16% of the cases, respectively. More patients died in end-of-life care wards in areas without (54%) than with (33%) 24/7 home care services (p = 0.001).ConclusionsIntegration of paramedics into end-of-life care at home is reasonable especially in rural areas without 24/7 palliative care services and outside of office hours. The majority of patients can be managed at home or with the help of an end-of-life care ward without an emergency visit.

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