Emergency ambulance care of families during death, dying, and bereavement: A document analysis of Australian and Aotearoa New Zealand clinical practice guidelines

Background: Ambulance personnel play an important role in supporting families during death, dying, and bereavement. Evidence-based clinical practice guidelines are crucial for ensuring high-quality ambulance care. However, it is unknown what guidance currently informs care of bereaved families. This document analysis examines ambulance guidelines pertaining to family care in out-of-hospital death in Australia and Aotearoa New Zealand. 

Methods: Clinical practice guidelines were sourced from all Australian and Aotearoa New Zealand ambulance services. Using qualitative document analysis, guidance addressing family care during death, dying, and bereavement was examined. Analysis was conducted using a customised coding framework informed by the Australian National Consensus Statement: Essential Elements for safe and high-quality end-of-life care. 

Results: While most guidelines included essential elements of end-of-life care, there was significant heterogeneity in the scope, detail and nature of guidance. Care instructions varied between services, populations and clinical scenarios. Guidance pertaining to culturally safe care was limited. 

Conclusions: Ambulance clinical guidance remains focused on technical skills during resuscitation, death, and dying. More guidance is needed to inform important elements of family care such as communication, family partnership, and cultural safety. Incorporating evidenced-based principles of end-of-life care presents an opportunity to improve ambulance support for bereaved families.