What is the nature of clinical guidance for paramedics providing family care in out-of-hospital death in Australia and Aotearoa New Zealand?
As part of her larger doctoral research project, PhD candidate Eillish Satchell undertook a document review examining clinical practice guidelines, that has recently been published in Australasian Emergency Care
When someone dies in the community, paramedics are often the first healthcare professionals to arrive. Family members are commonly present during these events and look to paramedics for comfort and support throughout this challenging time. How paramedics respond in these moments can make a big difference to family experiences and emotional wellbeing. Despite the significance of this role, paramedics often receive little training on how to support grieving families. Many paramedics report feeling unsure about what to say or do in these situations. This led us to ask, what organisational guidance do paramedics receive when it comes to supporting families during death, dying and bereavement? To answer this, we examined clinical practice guidelines (CPGs), which inform paramedic care from ambulance services across Australia and Aotearoa New Zealand, collating information about family care during death and dying. We compared information from ambulance CPGs to Australian national standards for quality end-of-life care to see if paramedic guidelines aligned with best practice recommendations.
What did we find?
One of the biggest takeaways was the significant variation between guidelines when it comes to caring for family after a death. Some organisations had detailed guidance on bereavement care, while others didn’t mention families at all. Often, we found that guidance was too brief and lacked detail on how to respond to the different emotional, psychosocial, cultural, and spiritual needs that families might have. Clinical guidance from Aotearoa New Zealand, however, was one of the leading organisations in considering cultural needs of families and culutral compentcy of paramedics when responding to an out-of-hospital death. We also found that guidance changed between clinical scenarios. Palliative care situations tended to include more direction for supporting family when compared to other emergencies, like sudden or unexpected deaths.
Improving family bereavement care: where to from here?
Supporting grieving families is one of the most emotionally demanding parts of a paramedic’s job. But when it’s done well, it can leave a lasting, positive impression that families often remember for years to come. That’s why it’s vital to ensure that paramedics have the right tools and guidance to respond to family needs. By increasing clinical guidance and policy with best practice principles, we can help paramedics feel more confident and better equipped to offer compassionate care in these moments.
It’s also vital that the voices of bereaved families help inform future care. Right now, their perspectives are largely missing from the policies and practices that shape out-of-hospital care in Australia and New Zealand. We’re currently working on research in New Zealand that explores what families need during and after these events. This will help us design future guidance and paramedic education that is more responsive to family needs during an out-of-hospital death.