# Integrating emergency medical services and palliative care: A nominal group technique

## TL;DR

This study explores ways to better integrate emergency medical services and palliative care in South Africa to improve patient care.

## Contribution

A structured approach using expert input to prioritize integration strategies between EMS and palliative care in South Africa.

## Key findings

- Top approaches include EMS administering prescribed medications and palliative care education for EMS personnel.
- Categories like awareness, education, and communication were identified as key for integration.
- Future research is needed to test the safety and effectiveness of these strategies.

## Abstract

The need for integrated healthcare has been increasingly recognised because of mounting challenges associated with the proliferation of injuries and noncommunicable diseases. A developing example of integration is between Emergency Medical Services (EMS) and palliative care. Despite recommendations for integration in South Africa (SA), these services remain segregated.

This study aimed to develop and prioritise approaches facilitating EMS and palliative care system integration within SA.

An online meeting was held with SA EMS and palliative care experts.

A nominal group technique was employed to answer the question, ‘What do you think should be done to most effectively integrate EMS and palliative care services in SA?’ Answers were categorised, awarded scores by participants, and ranked according to impact and feasibility.

The following categories were generated: Awareness, Education, Community Engagement, Communication and Information Sharing, Stakeholder Collaborations, Alternative Pathways and Approaches, Research, Funding, Policy Development and Governance. The top five individual approaches were: (1) enable EMS to administer already prescribed medications, (2) Emergency Medical Services undergraduate training in palliative care, (3) improve EMS recognition of signs of dying at the end-of-life, (4) palliative care awareness for the EMS community, and (5) palliative care awareness for in-hospital healthcare providers, particularly those in emergency medicine.

The categories developed in this study should be used to guide EMS and palliative care integration in SA. Future research should aim at establishing the safety and efficacy of these interventions.

This study provides a structured approach to integrating EMS and palliative care in SA, enhancing holistic care for patients with palliative needs.