Paramedic-delivered end-of-life protocol linked to far fewer emergency visits and more home deaths, Finnish cohort finds

A Finnish retrospective cohort study in the Journal of Palliative Medicine examined 767 cancer decedents and found that enrolment in a structured, paramedic-delivered end-of-life protocol (21% of the cohort) was associated with markedly different care patterns in the last month of life [Primary Study]. Enrolled patients had fewer emergency department visits (34% versus 48%, relative risk 0.55), more days at home in their last 30 days (median 21 versus 11), and a far higher home-death rate (26% versus 4%) than those not enrolled.

This is retrospective cohort evidence, not a randomised comparison: enrolment itself may be associated with other factors that also favour staying at home, and the design cannot rule out selection effects. It nonetheless demonstrates, at a population level, that a protocol delivered by ambulance services — not a specialist palliative care team — is associated with where people spend their final weeks and where they die.

For health systems under ambulance and emergency-department pressure, this is evidence for extending structured, resourced end-of-life protocols into ambulance services as a lever for shifting last-month-of-life care away from emergency admission and toward supported home death, alongside — not instead of — specialist palliative care provision.