Breaking bad news: the need for a coping mechanism in paramedicine

In his role as National Ambulance Director, Peter Bradley states in the foreword of the National End of Life Care Programme for Ambulance Services (Association of Ambulance Chief Executives 2012) that ambulance services are crucial in the delivery of high quality care at end of life. Step 1 of the Pathway outlined in the Programme states the need for ‘open, honest communication’ as end of life approaches. The 6 steps of the Pathway follow the care that ought to be provided for dying patients/relatives who are able to have time to consider advanced care planning. The programme includes the need for good organisation and coordination of service provision, and access to specialist palliative care and post bereavement support. For the ambulance services, the main focus in the Pathway is on ‘rapid discharge home to die’, and this focus makes sense if patients are known to be near their end of life. All too often, paramedics face situations where the patients' death is unexpected, and so, without time to prepare for end-of-life care. For such patients and their families, the End of Life Care Pathway (2012) is simply not appropriate.