Developments in public health paramedicine: exploring the professional practice of ambulance clinicians in palliative and end-of-life care in a remote and rural setting.

Aims: Professional practice in paramedicine is evolving rapidly, and with this evolution comes a growing ability - and responsibility - for paramedics to contribute to public health. Palliative and end-of-life care (PEOLC) public health is one such area where paramedicine has begun to contribute substantially and might still have significant untapped potential.This article explores developments in PEOLC paramedicine in the Scottish Highlands, an area classified as remote and rural, characterised by low population density, widely spaced communities and susceptibility to health inequalities created by access to healthcare, especially to specialist services. The role of paramedicine in PEOLC is examined in the context of public health priorities and policy, while considering the ability of paramedics to reduce health inequalities by widening access. Background: An informal literature search was conducted to identify interventions through which paramedicine can make improvements to the experience of death and dying on a population level, and lead to substantial healthcare cost savings. These interventions range from reducing PEOLC hospital admissions through effective use of advance care planning, just-in-case medications and independent prescribing and local referral pathways, to effectively managing palliative emergencies amenable to treatment in hospital. Conclusion: Paramedicine could thus play a significant role in making policy ambitions in PEOLC a reality, and conversely, achieving PEOLC policy ambitions might be difficult without support from paramedicine. Paramedics play a growing role in community healthcare provision, especially in remote and rural settings, by providing a link between care provided in the community and specialist services. Better integration of paramedicine into primary and secondary healthcare systems could facilitate turning more PEOLC public health theory into practice. The information collated in this discussion reinforces the need to reflect this potential in research funding allocation, in social and government policy development and in clinical practice decisions made by each individual paramedic.