A Study to Identify the Burden of Chronic Disease on a Private Emergency Medical Service in the Southern Sub-District of Cape Town, and if there is a Need for Palliative Care Provision in the Pre-Hospital Healthcare Sector

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Introduction Paramedics are often the first healthcare personnel to provide contact and care to patients with exacerbation of their chronic, non-communicable disease. Many of these patients will call for assistance multiple times during the trajectory of disease, and may benefit from a palliative care program. Currently, paramedics are not trained to manage patients requiring palliative care, nor provided with specialist palliative care consultation resulting in many patients being transported to hospital unnecessarily. Aim This study aims to describe the burden placed on Emergency Medical Services due to the number of patients with chronic Non-Communicable Diseases experiencing acute symptoms, and to assess whether palliative care in the pre-hospital sector should be considered. The objectives of the study include understanding whether patients with non-communicable disease symptoms were transported to a medical facility or remained at home, what clinical management they received, and whether there is a need for education, inter-disciplinary consultation, and provision of palliative care, in the pre-hospital environment. Methods This was a retrospective descriptive analysis of de-identified patient PRFs of adult patients, attended to by a private Emergency Medical Service (EMS) between January 1st, 2019, up until 30th April 2019. Results Of the 283 patients included in the study, many had more than one NCD, often experiencing more than one of the primary symptoms of pain, SOB, cognitive changes, and N&V simultaneously. The majority of these patients were likely to go to hospital with ambulance transport and frequently there was no appropriate clinical intervention by paramedics. Clinical advice was seldom sought by paramedics for patients with NCDs (cancer, chronic heart disease, chronic lung disease, dementia, and chronic kidney disease) experiencing symptoms of pain, SOB, cognitive changes and N&V, and it was evident that palliative care access, and availability, for patients was minimal. Conclusion Palliative care is a necessary approach to patient-centred care, with specifically trained EMS and paramedics being an available resource to assist with this approach. Access to available palliative/ home care networks, in conjunction with education and EMS support, will facilitate care for patients that have a need for palliative care support in the out of hospital context, and will limit the inappropriate transport of patients to already over-burdened Emergency Departments.