Juhrmann Madeleine L, Grindrod Andrea E, Gage Caleb H
Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
The Palliative Centre, Greenwich Hospital, HammondCare, Greenwich, NSW, Australia.
Palliat Care Soc Pract. 2023 Apr 13;17:26323524231163195. doi: 10.1177/26323524231163195. eCollection 2023.
Emergency medical services (EMS) are a unique workforce providing 24/7 emergency care across high-income countries (HICs) and low- and middle-income countries (LMICs). Although traditionally perceived as first responders to traumatic and medical emergencies, EMS scope of practice has evolved to respond to the changing needs of communities, including a growing demand for community-based palliative care. Public health provides a useful framework to conceptualise palliative and end-of-life care in community-based settings. However, countries lack public policy frameworks recognising the role EMS can play in initiating palliative approaches in the community, facilitating goals of care at end of life and transporting patients to preferred care settings. This article aims to explore the potential role of EMS in a public health palliative care approach in a critical discussion essay format by (1) discussing the utility of EMS within a public health palliative care approach, (2) identifying the current barriers preventing public health approaches to EMS palliative care provision and (3) outlining a way forward through priorities for future research, policy, education and practice. EMS facilitate equitable access, early provision, expert care and efficacious integration of community-based palliative care. However, numerous structural, cultural and practice barriers exist, appearing ubiquitous across both HICs and LMICs. A Public Health Palliative Care approach to EMS Framework highlights the opportunity for EMS to work as a linking asset to build capacity and capability to support palliative care in place; connect patients to health and community supports; integrate alternative pathways by engaging multidisciplinary teams of care; and reduce avoidable hospital admissions by facilitating home-based deaths. This article articulates a public health approach to EMS palliative and end-of-life care provision and offers a preliminary framework to illustrate the components of a potential implementation and policy strategy.
紧急医疗服务（EMS）是一支独特的专业队伍，在高收入国家（HICs）以及低收入和中等收入国家（LMICs）提供全天候的紧急护理。尽管传统上被视为创伤和医疗紧急情况的第一响应者，但EMS的业务范围已不断演变，以满足社区不断变化的需求，包括对社区姑息治疗的需求日益增长。公共卫生为在社区环境中构思姑息治疗和临终关怀提供了一个有用的框架。然而，各国缺乏公共政策框架来认可EMS在社区启动姑息治疗方法、促进临终关怀目标以及将患者转运至首选护理场所方面所能发挥的作用。本文旨在通过批判性讨论文章的形式探讨EMS在公共卫生姑息治疗方法中的潜在作用，具体包括：（1）讨论EMS在公共卫生姑息治疗方法中的效用；（2）确定当前阻碍公共卫生方法提供EMS姑息治疗的障碍；（3）通过未来研究、政策、教育和实践的优先事项概述前进方向。EMS有助于公平获取、早期提供、专家护理以及有效整合基于社区的姑息治疗。然而，存在许多结构、文化和实践方面的障碍，在高收入国家和低收入及中等收入国家都普遍存在。一种针对EMS的公共卫生姑息治疗方法框架强调了EMS作为一种连接资产的机会，以建立支持就地姑息治疗的能力；将患者与健康和社区支持联系起来；通过让多学科护理团队参与来整合替代途径；以及通过促进在家中死亡来减少可避免的住院。本文阐述了一种针对EMS姑息治疗和临终关怀的公共卫生方法，并提供了一个初步框架来说明潜在实施和政策战略的组成部分。
