Integrating palliative care and paramedicine to keep patients out of Emergency Departments and comfortable at home


In the healthcare sector, the intersection of paramedicine and palliative care is a critical yet often overlooked area. Dr Madeleine Juhrmann, a paramedic turned research fellow at the Flinders Research Centre for Palliative Care, Death and Dying (RePaDD), highlights the urgent need to address deficiencies in palliative care within paramedicine. Her research proposes a framework to enhance the role of paramedics in providing adjunct palliative care support to Australian communities.

Dr Madeleine Juhrmann

Dr Juhrmann’s decision to move into academia was spurred by her firsthand experiences as a paramedic student, where she encountered patients with life-limiting illnesses.

“Our scope of practice was limited to the extent that administering morphine for a patient with a life limiting illness becomes a challenge. The dosages needed to alleviate pain for someone in their end-of-life stage or with terminal cancer are beyond what we’re normally authorised and comfortable giving.” Dr Juhrmann explains. “This often leads to paramedics feeling compelled to transport the patient to the hospital, even if it goes against their wish to die at home, due to their fear of the potential medico-legal repercussions.”

Despite paramedics frequently encountering palliative care patients, Dr Juhrmann identified a notable gap in paramedic education regarding palliative care. This realisation prompted her to seek solutions through introspection and discussions with experts both domestically and internationally.

The challenges faced by Dr Juhrmann during her time as a student paramedic resonated with her colleagues worldwide. Whether in Australia or on an international placement in Costa Rica, paramedics encountered similar obstacles in providing comprehensive palliative care in the community. Paramedics often found themselves inadequately prepared to meet the diverse needs of terminally ill patients.

At the core of Dr Juhrmann’s research is the proposal of a framework that equips all paramedics with generalist palliative care knowledge, skills and scope of practice while allowing for specialisation for those demonstrating interest and aptitude. This approach not only addresses immediate practice gaps, but also ensures scalability and sustainability within the paramedic profession.

By standardising best practices nationally, Dr Juhrmann envisions a future where paramedics play a vital role in the continuum of palliative care.

“This framework aims to standardise best practices nationwide, ensuring all paramedics can provide palliative care aligned with other community services.”

Integral to the success of Dr Juhrmann’s framework is the integration of palliative care components into paramedicine education at both undergraduate and postgraduate levels. This initiative aims to normalise the inclusion of palliative care principles, thereby enriching paramedic practice and fostering a culture of patient-centred palliative care. Furthermore, Dr Juhrmann advocates for exploring innovative models, such as embedding paramedics within hospices, to expand their roles beyond traditional ambulance services.

Collaboration with stakeholders across ambulance services, academia, and healthcare policymaking is crucial for implementing Dr Juhrmann’s framework effectively. By fostering interdisciplinary dialogue and leveraging international expertise, Dr Juhrmann aims to tailor her framework to suit the unique needs of diverse healthcare environments, acknowledge the differences of metropolitan, regional, rural and remote settings, as well as underserved population groups.

Dr Juhrmann received funding through her PhD from The Hammond Care Foundation and Sydney Vital, but securing funding for the implementation and evaluation remains a priority, with Dr Juhrmann actively seeking support from government and NGO sources to advance her vision.

Dr Juhrmann’s passion for palliative care stems from her belief in its transformative potential to enhance end-of-life experiences for patients and their families. Recognising the alignment between paramedic skills and palliative care principles, she envisions a future where paramedics excel not only in providing care in traditional medical and traumatic emergencies, but also during expected deaths.

“I’m passionate about the potential of palliative care to improve end-of-life experiences for patients and families. Paramedics’ foundational skills make them well-suited for this role. Our research underscores how paramedics’ experiences in palliative care not only refine their crisis response abilities, but also benefit both patients and communities by prioritising dignity and quality of life.”

Dr Juhrmann’s research breaks down disciplinary boundaries, offering valuable insights into the interconnectedness of emergency medicine and palliative care. Through her advocacy and scholarly endeavours, Dr Juhrmann embodies a commitment to driving positive change within the healthcare landscape, one paramedic at a time.


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Death and Dying Palliative Care