A day in the life of…. A Clinical Paramedic Specialist

"There’s only a couple of hospices across the country that employ paramedics. It’s still really new.”

Caroline Phillips was a Paramedic in the London Ambulance Service when her interest in end of life care was first piqued. It was 2008 and Caroline was attending a dying patient who she knew wasn’t appropriate for the emergency department. She arranged for them to go to the local hospice as an in-patient and immediately noticed the difference between the hospice environment and A&E.

As she progressed in her career, she encountered the work of hospices first-hand on a number of other occasions and was intrigued by the patient-focus element of palliative care.

Caroline went on to work as a volunteer massage therapist in a hospice in London, then in Australia as a passive movement therapist for hospice patients with Motor Neurone Disease. Returning to London in 2018, she worked in a service development partnership between London Ambulance Service and MacMillan Cancer Care. It was here she met Nigel Dodds, former Consultant Nurse at St Christopher’s, and decided to pitch herself as a Clinical Paramedic Specialist (CPS) to the hospice. That, as they say, was that, and Caroline joined as our first CPS in a team of Clinical Nurse Specialists (CNSs).

From assessing patients via phone calls, to attending to someone in their home out of hours to provide symptom control, and much more in-between, they’re the front lines of our community nursing team.

Initially, Caroline feared she may be lacking skills in comparison to the rest of the community team, but soon realised everyone had different backgrounds with different experiences and skills.

“On paper, it’s a complete dichotomy being an emergency Paramedic saving lives versus a palliative care Paramedic when you’re helping people have good deaths. But it’s not as different as you might think.”

“Paramedics are ready-made for advanced assessment skills,” Caroline continues. “We’re skilled in taking a medical history and carrying out physical clinical examinations.”

A normal day on the community team as our Clinical Paramedic Specialist can go many different ways. It can be a day of phone calls in the office or doing video assessments, or it could mean visits to patients in the community. Alternatively, on a late shift, she’d take responsibility for the out of hours emergency visits to people at home. For Caroline, this is when her quick decision-making skills kick in, as she has to give injectable medications, put up syringe drivers and prepare people to die.

“It sits in my comfort zone of unpredictability and supporting heightened emotions. And that’s why I really enjoy this job, because it has a mixture of everything.”

There are two deaths of patients which stand out for her during her near-two years at the hospice.

One, just a short time into her role, was with a new referral who had been discharged from hospital into a nursing home. Since birth, the patient had been mute and deaf so Caroline communicated with him through sign-language, supported by his brother, and by writing on a pad. The man explained he has felt as though hospital and nursing home staff had ‘cast him aside’ because they couldn’t communicate with him. “He’d been working at a high level in IT and was self-sufficient and was incredibly angry at the way he had been treated, as well as his new loss of independence” she says.

“I apologised for the fact he felt unseen and unheard.”

After his death, Caroline did a follow-up call with his sister who remarked how grateful her brother had been for her visit. “That’s really pivotal to me,” she says. “It may not sound a lot, but as a Paramedic on an emergency ambulance you treat patients and leave them, you rarely get any closure or feedback.

“Given the angst about how he was being ignored,” she adds “I really hope that when he died, he had peace because he’d been able to say some of that stuff that he was holding onto. I hope he felt heard.”

The second standout experience was more recently when Caroline went to a patient on an emergency visit as a more experienced clinician. The patient was dying and clearly agitated, leaving a family member distressed. “I felt confident in my clinical practice, the patient responded well to the drugs and was calm and died in a place they wanted to be. And, while I was there, I was also able to support the next of kin who wasn’t necessarily expecting them to die that day. So that was pivotal for me to be there at the right time for both of them.”