Emergency medical services and palliative care: a scoping review.

OBJECTIVES: The aim of this study was to map existing emergency medical services (EMS) and palliative care literature by answering the question, what literature exists concerning EMS and palliative care? The sub-questions regarding this literature were, (1) what types of literature exist?, (2) what are the key findings? and (3) what knowledge gaps are present? DESIGN: A scoping review of literature was performed with an a priori search strategy. DATA SOURCES: MEDLINE via Pubmed, Web of Science, CINAHL, Embase via Scopus, PsycINFO, the University of Cape Town Thesis Repository and Google Scholar were searched. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Empirical, English studies involving human populations published between 1 January 2000 and 24 November 2022 concerning EMS and palliative care were included. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened titles, abstracts and full texts for inclusion. Extracted data underwent descriptive content analysis and were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. RESULTS: In total, 10 725 articles were identified. Following title and abstract screening, 10 634 studies were excluded. A further 35 studies were excluded on full-text screening. The remaining 56 articles were included for review. Four predominant domains arose from included studies: (1) EMS' palliative care role, (2) challenges faced by EMS in palliative situations, (3) EMS and palliative care integration benefits and (4) proposed recommendations for EMS and palliative care integration. CONCLUSION: EMS have a role to play in out-of-hospital palliative care, however, many challenges must be overcome. EMS provider education, collaboration between EMS and palliative systems, creation of EMS palliative care guidelines/protocols, creation of specialised out-of-hospital palliative care teams and further research have been recommended as solutions. Future research should focus on the prioritisation, implementation and effectiveness of these solutions in various contexts.

Emergency medical services and palliative care: protocol for a scoping review.

INTRODUCTION: The purpose of emergency medical services (EMS) is to preserve life and limb in emergency situations. Palliative care, however, is not concerned with 'life-saving' measures, but the prevention and relief of suffering. While these care goals appear to conflict, EMS and palliative care may be complementary if integrated. The aim of this scoping review is to map existing literature concerning EMS and palliative care by identifying literature types, extracting key findings and noting limitations using descriptive analysis. METHODS AND ANALYSIS: The framework of Arksey and O'Malley will direct this review. The following databases will be searched: MEDLINE via PubMed, Web of Science, CINAHL, Embase and PsycINFO. In addition, the University of Cape Town Thesis Repository and Google Scholar will be searched for relevant grey literature. Empirical studies concerning EMS and palliative care published between January 2000 and September 2021 will be included. Article selection will be performed and presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist. Extracted data from included articles will undergo descriptive analysis with findings being reported in a discussion format. ETHICS AND DISSEMINATION: This review will identify and describe existing literature concerning EMS and palliative care, highlighting key findings and knowledge gaps in the subject area. Findings will be disseminated to relevant stakeholders through peer-reviewed, open-access journal publication. As no participants will be involved and selected literature is publicly available, no ethical approval will be required.

Prehospital care providers' understanding of responsibilities during a behavioural emergency.

BACKGROUND: Prehospital emergency care providers are frequently called to assist with the management of mental healthcare users (MHCUs). The Mental Health Care Act no. 17 of 2002 regulates mental healthcare in South Africa, but the act fails to consider the responsibilities of prehospital emergency care providers in the provision of mental healthcare. Rather South African Police Services were given authority over the well-being of a MHCU in the prehospital setting. AIM: To investigate prehospital emergency care providers' understanding of their responsibilities towards MHCUs and the community during the management of behavioural emergencies. SETTING: The research was carried out at prehospital emergency care providers from the three main levels of care, currently operational within the boundaries of Pretoria, South Africa. METHODS: A grounded theory qualitative study design was chosen using semi-structured focus groups for each level of prehospital emergency care - basic life support (BLS), intermediate life support (ILS) and advanced life support (ALS). Data from each focus group were collected through audio recordings and transcribed and analysed using a framework approach. RESULTS: A total of 19 prehospital emergency care providers participated; two focus group interviews were performed for each level of care. The BLS focus groups each consisted of two participants. The ILS focus groups consisted of three participants each, and the ALS focus groups consisted of six and three participants. Four key themes were identified: perceptions of behavioural emergencies, responsibilities, understanding of legislation and barriers experienced. CONCLUSION: Participants placed high value on their moral and medical responsibilities towards MHCUs, which they described as ensuring the safety of themselves, MHCUs and the community; preventing further harm; and transporting MHCUs to an appropriate healthcare facility. There was a desire for revision of legislation, better education, skill development and awareness of mental healthcare in the prehospital emergency care setting.