End of Life Care

NPO

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Does anyone have protocols for treatment of hospice patients for comfort care in the home? I'm interested in things like respiratory support for comfort, pain management, etc.

I'm interested in examples with and without community paramedic involvement.
 
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NPO

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NC has a MOST form (Medical Orders for Scope of Treatment) The patient and physician can decide what kind of treatment the would like.
Patients have more choices than with a DNR. They can accept BVM ventilations but request not to be intubated ect....
Most states have something like this, but I'm curious about any EMS protocols out there specifically giving treatment guidelines.

I did see Kansas City has one.
 

Tigger

Dodges Pucks
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My previous job briefly partnered with a hospice program to fill in as the night time on-call response. Their nurses were coming from 45 minutes away so the idea was that the patient/family could call and get an ambulance and then the paramedic would figure out what was going on and talk to the hospice nurse and come up with a plan. We were able to give narcotics as outlined in the patient's care plan but would usually assist the patient with their comfort medications instead. There was no set hospice guideline for us, it was decided that we could use the narcs as the guidelines already outlined and we don't call in for refusals so it wasn't like a doctor would force you to bring them in. Our MD was just comfortable with the paramedic's judgement. We would still do a refusal/treat and release. Unfortunately there was a lot of shake up with the hospice program and their leadership stopped engaging with us and the program...passed on. It was also pretty much impossible to get reimbursed by hospice.

The agency now has a community paramedic program that wants to assist with hospice but so far there still isn't much interest and there are now more local hospice nurses.
 

Aprz

The New Beach Medic
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