Evaluation of paediatric palliative care ambulance plans: A retrospective study

Area of Science:

• Pediatric Palliative Care
• Emergency Medical Services
• Health Informatics

Background:

• Paediatric Palliative Care Ambulance Plans are utilized by New South Wales Ambulance to address the needs of children with life-limiting conditions.
• Understanding the utilization and impact of these plans is crucial for improving care coordination.

Purpose of the Study:

• To describe the population of children utilizing Paediatric Palliative Care Ambulance Plans.
• To analyze Plan completion rates, paramedic responses during ambulance callouts, and the alignment between Plan recommendations and actual paramedic interventions.

Main Methods:

• Retrospective analysis of 141 Paediatric Palliative Care Ambulance Plans lodged between January 2017 and December 2019.
• Coding of demographic information, care preferences, and medication suggestions from Plans.
• Analysis of 199 associated paramedic callout records from January 2018 to December 2019 to assess paramedic responses.

Main Results:

• 38% of Plans suggested medications outside standard paramedic scope.
• Common callout reasons included symptom management, planned transfers, and end-of-life care, with over two-thirds occurring after-hours.
• While paramedic interventions generally aligned with Plan recommendations, Plans were only documented as sighted in 25.3% of callout notes.

Conclusions:

• The study characterizes children with life-limiting conditions using Paediatric Palliative Care Ambulance Plans and their associated emergency service interactions.
• Paramedic actions were consistent with Plan goals, but the extent to which Plans influenced paramedic decision-making is unknown, highlighting a gap in understanding care integration.