The call came in just before midnight. An elderly male with severe abdominal pain. He had end-stage lung cancer and had been treated for a cardiac event earlier in the day.
“In the past, when I responded to palliative care calls, I would feel clumsy with a pit in my stomach,” says Advanced Care Paramedic Brock Browett. “Paramedics are trained to get patients to the hospital ASAP, but palliative care is an entirely different paradigm.”
This call was different. The weekend before, Brock had taken the LEAP™ Paramedic palliative care training course, which was offered in the Niagara region of Ontario where he works. The training equipped Brock to handle the call and empowered him to have difficult conversations with patients and their families.
“In palliative care, it’s all about the patient,” says Brock. “It’s okay to let them guide their own care, to talk about how they want to die.”
Brock and his partner attended the call. They went upstairs where the man was doubled over in pain. Brock took the man’s history and did an assessment. He helped the man get comfortable and fitted an oxygen mask to help him breathe. It was clear that the man was dying, and it was up to Brock to have an honest and compassionate conversation with him and his family.
“I asked him how he wanted to die,” Brock says. “Everything I learned in LEAP™ just clicked—I’ve never had that conversation before in my career.”
The man wanted to die at home with his family. Not in an emergency room. Not in pain.
Together with the patient and his family, Brock made a plan to dispense morphine to ease the man’s pain. But before he could administer the plan, Brock needed the approval of his base hospital physician.
“The LEAP™ training let me use higher level language to explain the situation,” says Brock. The base physician gave their approval to administer morphine and make the man comfortable.
After Brock spoke with the base physician, a friend of the patient had called Dr. Kim Adzich, a palliative care specialist who had just started treating the patient.
“Brock gave me his assessment and presented his plan,” says Dr. Adzich. “The family wanted to avoid the emergency room and Brock said he would stay until the man’s pain was under control.”
Brock returned to the bedroom for another important conversation with the patient. He made sure the man understood that he would die if he stayed home. The man said he understood and reiterated that he wanted to die at home. Brock and his partner got to work making him comfortable.
Typically, a paramedic call takes 25-30 minutes; Brock and his partner stayed with the patient and his family for 2.5 hours. They communicated openly with the family to make sure they were on-board and understood what to expect when the patient died. And then—they gave the family their privacy.
“Death is a very personal experience,” says Brock. “My partner and I stayed downstairs in the kitchen and checked in with the patient every so often.”
At around 2:30 a.m., Brock and his partner returned to base. Then the family called back. The patient had died. Brock wanted to take the call and get closure on the emotionally charged event.
“The family was grateful that he died comfortably at home,” says Brock. “They were able to start grieving in a peaceful way.”
The next day, Dr. Adzich called the patient’s wife. “She said Brock was an angel—compassionate and caring,” says Dr. Adzich. “He did an excellent job managing the patient’s symptoms and enabled him to die at home with his family.”
Brock credits LEAP™ Paramedic training with giving him the practical tools to handle palliative calls like this one. “It’s hands down the best training I’ve taken in 10 years,” says Brock. “It gave me the in-depth medical knowledge I need to explain things to patients and also to communicate effectively with other health care professionals.”
As a palliative care specialist, Dr. Adzich is also a LEAP™ facilitator. He said that when leading LEAP™ Paramedic courses, many Emergency Medical Service (EMS) professionals told him they found calls involving palliative patients to be stressful. “They felt so powerless because they were obligated to transfer patients to the hospital, even if it was against the patients’ wishes,” Dr. Adzich says. “They said the LEAP™ training lifted their moral distress because they have the option to have these conversations and patients can stay home if they want to.”
When paramedics and other health care professionals speak the same language and work toward the same goal, palliative care can be integrated at home. Dr. Adzich says palliative care is a team approach; LEAP™ Paramedic training expands the team.
“I’ve been a paramedic over 10 years and that call in May was the highlight of my career,” says Brock. “Had I not had LEAP™ training, it would have gone very differently.”
Learning Essential Approaches to Palliative Care (LEAP™) Paramedic is a blended learning course for paramedics and Emergency Medical Service professionals that teaches the essential practical knowledge, attitudes, and skills to provide a palliative care approach on-site. LEAP™ Paramedic is taught by local paramedic experts and experienced palliative care practitioners.