OP-9 Paramedic decision-making at end of life

Introduction Increasing demand for end-of-life care due to ageing populations and rising multimorbidity are being faced globally. Consequently, ambulance attendance at end of life is a growing concern. In England and Wales, 55% of people who died used an ambulance at least once in their final three months (range 1-38 times), whilst in Scotland, 77% used ambulance services in their last year.1 2 UK costs are substantial with ambulance care for end of life patients estimated at £425 million annually.3 Despite this, very little is known about the exact nature of paramedic work at end of life4 and what influences decision-making in this context. Aim To conceptualise ambulance paramedic work at end of life and factors influencing decision-making. Methods A mixed Methods design was employed: online survey capturing paramedic practices and influencing factors, and in-depth case studies of service provision utilising vignette methodology to explore decision-making. Results 920 paramedics across England completed the survey,5 and 101 patients, carers, and healthcare professionals participated in interviews, focus groups, and ambulance record reviews. Paramedic work was focused on those perceived to ‘have slipped through the net’ and involved emotionally demanding work bordering on moral distress. Key influences on decision-making included limited education and training in end-of-life care, organisational and individual perceptions of such care, working with incomplete information (‘in the dark’), restricted access to collaborative decision-making (challenges ‘safety netting care’), and challenges accessing and administering medications. Conclusion These factors contribute to paramedic fear of ­making the wrong decisions at end of life and of being reviewed. A conceptual model of paramedic decision-making at end of life will be presented, alongside key recommendations for enhanced education and training, and improved access to patient records, 24/7 palliative care advice, and anticipatory medications to better support paramedics in this critical yet under-supported role. References Johansson T, Pask S, Goodrick J, et al. (2024) Time to care: findings from a nationally representative survey of experiences at the end of life in England and Wales (Research report). Marie Curie, London. Mason B, Kerssens J, Stoddart A, et al. Unscheduled and out-of-hours care for people in their last year of life: a retrospective cohort analysis of national datasets. BMJ Open 2020;10:e041888. Cummins L, Julian S, Georghiouo T, et al. (2025) Public expenditure in the last year of life (Research report). Health Economics Unit, Nuffield Trust & Marie Curie, London. Juhrmann ML, Vandersman P, Butow PN, et al. Paramedics delivering palliative and end-of-life care in community-based settings: A systematic integrative review with thematic synthesis. Palliative Medicine 2022;36(3):405–421. Campling N, Turnbull J, Richardson A, et al. Paramedics providing end-of-life care: an online survey of practice and experiences. BMC Palliative Care 2024;23(1):297.