Bridging Gaps in End-of-Life Care: A Statewide EMS Hospice Protocol for Pennsylvania

Key Message: Development of an emergency medical services (EMS) protocol for hospice patients in Pennsylvania aligns emergency care with patients' end-of-life wishes. Created with stakeholder collaboration, this protocol addresses symptom management and minimizes unnecessary interventions to enhance patient-centered end-of-life (EOL) care thereby bridging a critical cap in prehospital hospice support.

Abstract: Background
EMS personnel are often dispatched to care for patients enrolled in hospice. However, most lack formal training or clinical protocols guiding EOL care, resulting in goal-discordant medical care (e.g., hospital transport) and patient and family distress. To address this, the National Association of EMS Physicians and the American Academy of Hospice and Palliative Medicine have endorsed the development and implementation of patient-centered EMS hospice protocols. This session will evaluate the steps that were used to develop this protocol, discuss the importance of stakeholder engagement, and examine lessons learned for others who want to produce something similar.
Approach
Through didactic format, participants will learn about steps in protocol development, starting with a comprehensive review of Pennsylvania’s existing ALS and BLS protocols, medication formularies, and scope of practice documents, as well a national recommendations and hospice protocols from other states. Next, we will examine methods to obtain robust stakeholder engagement from EMS and emergency medicine physicians, hospice and palliative care experts, and EMS personnel. We will evaluate why extensive collaboration with stakeholders is needed, focusing on discussing the need for this protocol with stakeholders. We will analyze the iterative process and themes that were discussed during protocol drafts. Throughout the session, we will discuss lessons learned, including how to develop a new protocol while respecting existing state guidelines. The session will close with the final protocol being reviewed; followed by open discussion/ questions.
Implications
The protocol, "Care of the Hospice Patient," was accepted by the EMS West regional council and submitted to the Pennsylvania Department of Health for consideration of adoption into the statewide EMS protocols. The protocol addressed EOL symptom management, hospice team coordination, and support for non-transport when appropriate. Notably, this is the first EMS hospice protocol to explicitly include pediatric medication dosing, addressing an important gap in care.

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