The use of emergency medical services for palliative situations in Western Cape Province, South Africa: A retrospective, descriptive analysis of patient records
Gage et al. · South African Medical Journal · 2023
Retrospective descriptive study · Patient record review · n = 395 patients / 494 transports
Palliative Care · EMS · South Africa · Scope of Practice
Written by: Pat Leighton
● Clear Methodology ● Retrospective Design ● Two Hospitals Only ● Single Province ● COVID-19 Year
A third of patients receiving palliative care at two Western Cape hospitals arrived by EMS for symptoms that fall within the EMS scope of practice. Yet EMS and palliative care in South Africa remain poorly integrated.
Estimates indicate that 56.8 million people require palliative care annually, while only 14% receive such care. This imbalance is particularly acute in low-to middle-income countries (LMICs), where up to 80% of patients requiring palliative care reside.
Existing data suggest that up to 10% of EMS callouts may be for patients with palliative care needs. Previous work by Gage et al found that SA paramedics reported frequently encountering palliative situations, but the numbers were lacking. This study set out to fill that gap.
The researchers reviewed records from two state hospitals in the Western Cape (one district and one tertiary) for all patients who received palliative care during 2020 and arrived via EMS. They extracted data on patient characteristics, chief complaints, diagnoses, and outcomes.
of palliative care patients arrived via EMS (395 of 1 207)
EMS transports over the year (~41 per month)
chief complaint was dyspnoea
of patients ultimately discharged home
The median patient age was 60 years, and most were male (54%). Family members were the primary caregiver in 89% of cases, reflecting the home-based care reality for most patients with palliative needs in the Western Cape. Cancer was the most common diagnosis (32%), followed by cardiovascular disease (12%) and renal disease (13%). HIV/AIDS accounted for 5% of cases.
Dyspnoea (36%) and pain (16%) were the most frequent presenting complaints, which are both well within the scope of practice of EMS providers to manage. Of significant concern, 36% of patients transported by EMS died in hospital. Many short-stay admissions (27% stayed 0–3 days) likely represented unnecessary transfers that EMS and palliative care integration could have avoided.
EMS providers are already providing palliative care, although in many instances they are under-equipped. The burden of palliative patients is likely to increase with an aging population with increasingly complex medical needs.
The majority of patients with a terminal illness would choose to die at home, however, they may have symptoms that are distressing for themselves or their family members resulting in activation of EMS. The finding that 38% of transported patients died in hospital (many after only a short stay) suggests these patients may have been better managed at home with the appropriate support.
EMS providers in SA are already trained to manage dyspnoea and pain, including with morphine, although typically in emergency contexts rather than palliative ones. The HPCSA’s Clinical Decision Support Tool (2025) provides guidelines for ECP’s and ANT’s to provide subcutaneous morphine, benzodiazepines and antiemetics to palliative patients, and supports meeting patients wishes regarding transport to a facility.
Addressing this gap requires training practitioners both in opioid use for palliative pain and dyspnoea; and in recognising when a palliative approach, including family support and non-drug measures, is appropriate.
