The Dying Patient: Palliative and End of Life Care: Part 3

In Part 3 of The Dying Patient: Palliative and End of Life Care,
we delve into the complexities ambulance clinicians face when
supporting patients in their final days and hours. Often the
first to recognise when someone is dying, paramedics work within
a system where community engagement may be limited, making their
role crucial in identifying signs such as terminal agitation,
unconsciousness, and other common symptoms. The episode discusses
the importance of anticipatory medications and
proactive advance care planning , especially in
situations involving carer breakdown or when patients change
their minds about where they wish to die.


We explore why ambulance services are frequently called during
end-of-life stages, whether due to uncontrolled symptoms, sudden
deterioration, or emotional distress within families. Paramedics
not only offer symptom relief, both pharmacological and
non-pharmacological, but also provide vital emotional support to
those navigating grief, denial, or fear. Challenges include
differentiating between reversible conditions and active dying,
managing care when anticipatory medications are unavailable, and
coordinating with wider healthcare teams.


Breaking bad news is another critical area discussed, with a
focus on using frameworks such as Ask-Tell-Ask and adapting
communication to the emotional needs of the moment. Lastly, the
episode reflects on cultural considerations in a city as diverse
as London. From language barriers and different expressions of
grief to religious rituals and care after death, ambulance
clinicians must remain adaptable and compassionate, ensuring that
care is respectful, inclusive, and sensitive to the needs of
every individual and their family. Some of the links to
information mentioned in the episode can be found here: These are
some of the resources mentioned in the episode:


Breaking Bad
News: ⁠⁠https://www.sth.nhs.uk/clientfiles/File/Breaking%20bad%20news%20Reflection%20on%20the%20process.pdf⁠⁠



Good Grief - understanding the grief journey in more
detail: ⁠⁠https://good-grief.org/resources/⁠⁠



Hospice UK, an excellent place for further
resources: ⁠⁠https://www.hospiceuk.org/our-campaigns/dying-matters/dying-matters-awareness-week

UK National Guidelines on Diabetes and End of Life Care:
https://www.diabetes.org.uk/sites/default/files/2025-03/EoL_TREND_2024_v11-1.pdf






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