• End-of-life care within the paramedic context

      Wilson, Caitlin (2020-11-09)
      Edited by Tania Blackmore (2020), Palliative end of life care for paramedics provides a comprehensive overview of palliative and end-of-life care within the context of paramedic practice. This recently published book is in its first edition and is available in paperback (£29.99) or eBook (£24.99) format. It sits alongside similar publications from the College of Paramedics such as Law and ethics for paramedics and Independent prescribing for paramedics. Some of you may have noticed that these book topics reflect a selection of the paramedic e-Learning modules, which are freely available for College of Paramedic members through the e-Learning for Healthcare Hub website or via My ESR for NHS employees. The subjects covered in the ‘Paramedic – End of Life and Palliative Care’ e-Learning module loosely reflect those covered in this book; however, the book covers everything in much more detail, and includes many references to current supporting evidence, providing the reader with a greater background understanding of palliative care. The team of authors is a well-balanced mixture of academic and clinical health professionals, with three from a paramedic background and three end-of-life care specialists. The front cover of the book indicates that this book is supported by the College of Paramedics, which hints at its incredible relevance for paramedics and emergency ambulance technicians practising in the UK. Sometimes when being taught by specialists outside of the ambulance service, they impart an immense amount of specialist knowledge, yet prehospital clinicians have to decide for themselves how much is actually within their scope of practice and therefore applicable to their clinical role. Although, the editor includes a (very valid and important) disclaimer at the beginning of the book that ‘healthcare professionals should always follow local procedures and be aware of their own scope of practice’, this process of critical appraisal and judgement on applicability is made much easier by the book's close alignment with UK paramedic practice and the frequent references to the JRCALC Clinical Guidelines 2019 (Association of Ambulance Chief Executives (AACE), 2019). In fact, in that way, it is similar to the Emergency birth in the community book that I reviewed in a past issue of the Journal of Paramedic Practice (Wilson, 2019), which was supported by the AACE and JRCALC. The book takes the reader on a logical journey beginning with the broader historical, social and cultural debates about death and dying in chapter 1, followed by the various definitions of palliative care in chapter 2. Chapters 3 and 4 provide an overview of palliative care emergencies and how to recognise them, followed by guidance on symptom management. Subsequently, chapter 5 focuses on softer skills such as communication, while chapter 6 provides an overview of caring for the dying patient, delirium, medication management and discussions surrounding what may constitute a ‘good death’. Chapters 7 and 8 address the topics of ethics and professional resilience, before chapter 9 ties everything together under the title ‘the paramedic as an end of life care specialist’. A clear favourite within this book was chapter 4, which covers symptom management and seemed so applicable that it may join my ever-growing collection of ‘keep-in-helmet-bag’ books. I also really liked the many visuals, such as the image displaying the relative strength of opioids and others illustrating pain pathways and causes of vomiting and nausea. The authors have also included many educational tables, which in chapter 3 provided useful information on manifestations, relevant considerations and treatment for various palliative care emergencies such as neutropenic sepsis, superior vena cava syndrome and terminal haemorrhage. Although it will be impossible for me to remember all of these details, it will be easy to refer to these tables when thinking through differential diagnoses or reflecting on patient encounters. A great learning tool within this book are the case studies included at the end of most chapters. These cases add a practical element to the book and allow the reader to reflect upon what has been discussed in the chapter. However, many of the case studies and associated questions are complex in nature and although they are likely to have more than one right answer, there will definitely be wrong answers. I wonder if, in subsequent editions, the authors could include potential answers or discussions at the end of the book to ensure that readers are following along the right lines. I found the book to be a bit of a slow starter, as the authors use chapters 1 and 2 to introduce the reader to a wide variety of palliative care policies and frameworks in the UK. Although presented in a structured way, it is at times difficult to see how they fit together and which ones apply to paramedics. For those readers finding themselves similarly confused, I would suggest first turning to chapters 3 or 4 and then revisiting the earlier chapters to learn about the broader picture of palliative care. I think working through this book would make a useful exercise for continued professional development (CPD) as part of a paramedic portfolio or even the associate ambulance practitioner programme. In fact, the title, Palliative and end of life care for paramedics may be slightly misleading: this book is by no means solely suitable for qualified paramedics; emergency ambulance staff in other roles such as emergency medical technicians or clinical advisors within the emergency operations centre would definitely benefit from reading this book, although would have to adapt some of the advice to their own scope of practice. Overall, this book is written in simple and easy-to-understand language, provides excellent tips for further reading and cites relevant and up-to-date references throughout—what's not to love? Well, very little to be honest. I have already recommended this book to several colleagues and feel my own care of patients approaching the end of their life has improved since reading this book. I certainly feel more confident and will likely turn back to this book to answer any prehospital palliative care questions I may face in the future. The best way to summarise this book is by expressing my full agreement with the statement on the back cover: ‘it is essential reading for [prehospital clinicians] hoping to better understand the complexities of caring for patients approaching the end of life’. Abstract published with permission.