Impact of paramedics carrying just-in-case end-of-life care medication

Abstract

Background: Early in the COVID-19 pandemic, it was predicted that frail community patients with symptoms of severe COVID-19 infection may need urgent symptom management—and that unless they had already been identified as being in their last weeks of life, they would be unlikely to have just-in-case (JIC) medications at home. The Welsh Ambulance Services NHS Trust therefore placed JIC medications on emergency ambulances to increase symptom management options for paramedics treating patients with symptoms of severe COVID-19 infection and/or associated with advanced end-stage illness. Methods: A review of medications to palliate symptoms of severe COVID-19 infection and advanced and terminal illness was undertaken. A verbal order process was implemented, allowing prescription-only medications to be administered by paramedics. Guidance, training and data capture processes were designed and implemented. Results: Symptoms associated with advanced cancer were the main reason for giving ambulance-based JIC medications, and midazolam and morphine were the most administered medicines. No adverse incidents were reported or recorded. Conclusion: Ambulance-based JIC medications were and continue to be appropriately administered, irrespective of life-limiting illness diagnosis. Although carrying JIC medicines on ambulances was introduced in response to the COVID-19 pandemic, 12 months of data collection indicates this is a safe, cost-effective, patient-centred practice.