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Hospice & Palliative Care: Treating a Person - NOT a Disease

Source: Quest Healthcare

As unfortunate as it is, we've all been there when a loved one gets diagnosed with a serious or incurable illness. It could be cancer, dementia, or ALS to name a few. Panic sets in not only for the patient, but also for the immediate families who will often assist in their care. The transition to death is evident for all of us. Palliative care is here to make the transition a smoother and dignified ride for all. This care requires lots of active participants and many times EMS gets involved when the hospice related care is delivered in a home environment within your jurisdiction. However, please know that palliative care can be given during any stage of a serious illness and it is not always associated with those that are dying. I will reinforce this again later.....

The good news: Is that this is a great time to be alive as in most developed countries the average life span reaches or exceeds 80 years of age - an upward trend.

The bad news: Is that since the dawn of man, the death rate has been very consistent -- 100%. We have to face this reality, even if the health news is unexpected, sad and tragic, none of us can avoid deep personal loss. Palliative care helps us lean into improving the quality of life for people with serious illness. It should NOT always be considered end-of-life care.

In this vein, enrolling in hospice care, when the time is right may be more beneficial than a 911 call. Avoiding IV's, antibiotics, aggressive ventilatory support, chemo, PET scans, invasive procedures may be able to delay the inevitable, but does it increase the quality of one's life when the disease process has fully progressed?? That is a question that only you and your family can answer as every situation is different. Consider that maybe specialized (and personalized) hospice care can be a better alternative. The care could also be delivered in conjunction with or in addition to any of the treatments listed above if you wish. It doesn't have to be complicated and can come in the form of simpler ideas like: round the clock analgesics, a cold cloth, and a large, quiet, comfortable room where the entire family can visit whenever they wish. The later decision around palliative care takes courage and only happens when the right questions are asked.

25% of all Medicare spending annually is for the 5% of patients who are going to die. A tremendous amount of spending for a very small group of patients. High costs in the last years of life are to be expected, BUT despite the spending, the quality of care is usually poor. Think about it -- in EMS how many times have you been in the hospitals to see patients receive care they don't necessarily want. How much of that care provided directly provides them with a benefit. Palliative care provides a bridge to see that they get the treatment they want - treatment they can indeed benefit from. Long, complicated stays in an ICU usually brings amount more suffering. Something we do not want for any of our family members.

I'm not saying that ICU is not appropriate for some patient populations. Patients get discharged home from the ICU every day. I'm talking about another patient population. A group of patients with many extended hospital stays where it's evident to everyone that the patient is not getting better. The patient's quality of life and clinical condition are both in decline. As EMS providers, you have a great foundation of medical knowledge, use it to help better educate your patients when presented with the opportunity. This could be completed with a simple conversation with the nursing staff or even social workers located in the emergency departments before you depart for your next call.

Many studies exist that reinforce that palliative care helps patients with serious medical illnesses live BETTER. If palliative care were a drug - EVERYONE SHOULD GET IT!!

If you ever respond to a patient who has opted into home hospice, remember to honor the patients/families wishes. Realize that they are struggling and fatigued. Help support them and the patient on their last journey with grace and dignity.

In medicine, we may not always be able to change the outcome, but in EMS, you will sometimes be placed in situations where you'll able to positively affect the patient journey.


November 20, 2023

Author: Joshua Ishmael, MBA, MLS(ASCP)CM, NRP

Pass with PASS, LLC.

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