National prevalence of palliative care protocols in emergency medical services

There are approximately 500,000 hospice patients in the United States. While hospice patients may desire only palliative care, they often access the emergency medical services (EMS) system, unaware that many EMS systems do not have specific palliative care protocols. This study was undertaken to determine the prevalence of palliative care protocols among EMS agencies in the United States, and to estimate the percentage of the U.S. population covered by such protocols.

A survey requesting information about out-of-hospital palliative care protocols was mailed to the EMS agencies serving the 200 most populous U.S. cities. After four weeks a follow-up telephone call was made to those agencies that had not yet responded. The number of agencies with a palliative care protocol was determined, and the populations served by those agencies with and without palliative care protocols were calculated.

Responses were received from 121 (60.5%) of the cities. Only seven (5.8%) of the responding cities' EMS agencies had a palliative care protocol. The population of cities covered by a palliative care protocol was just under 3 million, or slightly more than 6% of the 47.2 million people living in the responding cities.

Most of the U.S. population is not served by an EMS agency with specific palliative care protocols. Until more EMS systems enact specific palliative care protocols, physicians treating the terminally ill should educate patients and families about appropriate use of the EMS system, and that EMS professionals may be required to provide more than supportive care.