Death, dying, and end of life issues

Just as EMS medical directors have an obligation to ensure high-quality medical care by the EMS clinicians that they supervise, they also have an obligation to ensure high-quality, compassionate, and medically appropriate end of life care. This includes protocols and education to determine when to and when not to provide resuscitation and other life-sustaining treatments as well as transport decisions that are based on ethical principles and patient preferences and are documented and communicated by various means and tools. Clearly defining when and how to discuss, document, and amend treatment based on patient goals is paramount in end of life care. The POLST paradigm is a proven and growing method for communicating end of life wishes and an important tool. EMS clinicians should engage with and understand what end of life resources are available in their communities, such as hospice programs. Planning should occur for circumstances where end of life care could be greatly affected, such as a pandemic. Additionally, when a field death does occur, EMS clinicians must provide support to the grieving survivors left behind.