As an EMS professional, the parts of your job that entail racing to a scene and saving lives are sometimes glamorized. Yet, when you provide ambulatory care, you encounter all kinds of people in different medical situations. Not everyone thinks about working with hospice patients in EMS. You will encounter people in hospice–or palliative care–and it can be quite a different experience than working with other types of patients. There are both practical and emotional considerations you should think about.

Where EMS Meets Palliative Care

Fire Engineering says, “More and more, the worlds of hospice and EMS are intersecting.” You might transport someone from one facility to another, or back home for the last part of their life. In these situations, you will interact with the patient as well as family members, nurses, nurses’ aides, and case managers.
You may be called to an emergency for a hospice patient. Although family caregivers are instructed not to call 911 once someone is in hospice, they may do so when there is an acute change or onset of new symptoms. You may not know immediately when responding to such a call, that the patient is receiving end-of-life care.
Hospice patients often, though not always, have DNR or RMA orders. It is crucial that you know, of course. A DNR order doesn’t preclude other types of intervention, however. EMS World points out, “…often, the distinction between an order preventing initiation of CPR and an order preventing initiation of other necessary medical treatment can become blurred.” Therefore t is important to remember that “a DNR order only indicates that CPR should be withheld in the event of cardiac or respiratory arrest.”
In addition, as Fire Engineering advises, “EMS personnel should also remember that, in most states, it should employ comfort measures with a DNR patient.”

Learn the Regulations in Your State

Each state has its own regulations defining and dictating hospice or palliative care. Some get more specific than others. If you work in Ohio you can find the state’s definition on their website. Medicare also has its own set of guidelines pertaining to what it does and does not cover. For example, it may not cover a trip to the emergency room for a hospice patient.

What You Can Learn From Hospice Nurses

Hospice nurses learn quickly how to handle death and how to stay positive in emotional situations. They often view their work as an honor. To be present in a person’s last moments on earth, and to share that with a family, is truly special. They also know that their job is to mitigate suffering at the end of life.
Hospice worker Sarah Stroe wrote, in a piece for the Huffington Post: “In assisting individuals and families through the dying process, we are also showing them how to continue living. To provide comfort to patients and their families and to do so with dignity, to lead by example in living a life that is affected by death but not overshadowed by it lets families know that they can do the same.”
Nursing blog urges, “Just realize that the suffering you see in hospice may actually be a lot less dramatic than what you see in the ER, ICU, or trauma. Most hospice deaths are actually very peaceful.” If ever you find yourself on the scene of someone’s last breath, you can take this advice to heart. Encountering hospice patients in EMS can actually be quite fulfilling.

Ask for Help

Your agency may provide minimal training on how to work with end-of-life patients. If you feel less than confident in your knowledge, bring it up to your superiors. In addition, speak with colleagues who have experienced more interaction with hospice care. They may offer advice and insight. As with other aspects of your job, take care of your own mental health. Trauma can take a toll but resources are out there. Finally, seek out related training as you pursue CLEs. Your career is one where you always grow and learn new things, so make working with hospice patients part of that growth. It can be a truly rewarding experience.