Chapter 2: Operational factors

Accessing resources and expertise

The paramedic says
Tristan outlines the unique challenges of providing care in rural settings. (3:22)

In some instances you may arrive at a call with no advance knowledge that the patient is receiving palliative care, or isn't receiving palliative care but is at the end of life. Information about the illness, symptom issues, family dynamics, decision-making and other pertinent details won't be available. When this happens, you may find yourself starting from the ground up on what may be a very complex medical situation. 

Where to start

Some people receiving palliative care will be followed by an interdisciplinary health team and often have home care services and other supports in place. When the patient’s physician or other health team members are available, they can provide a synopsis of the care history and assist you in navigating care issues. Speaking with them if they are on scene or available by phone adds a valuable component of care.

However, you may have to play multiple roles when:

  • The patient doesn’t have a physician and/or support services in place.
  • No services exist, which may be more common in small rural and remote communities.

  • Services are limited to regular business hours.

  • Other community providers are not available to attend the patient’s home or respond to calls during regular business hours due to commitments to other patients.

Sources of information

Refer to your community guidelines, which will outline policies and procedures for contacting other health care providers (for consultation). Note that some of the following may not apply to you.

  • Some patients may have an advanced care plan, health directive or goals of planning document. For more information, see Module 4, Decision-making.
  • The patient's direct care team, if available. 
  • In some areas, members of a palliative care team are available for consultation. 
  • Additional support may sometimes be needed from a backup crew with a higher scope of practice. 
  • An operations supervisor may also be able to provide additional support and guidance in complex situations. 

These resources may be limited in rural settings, posing an additional challenge.