Work and support with “the end in mind”(Mannix 2017) Current model ineffective- not sustainable ED is not suitable for providing end of life care (Gloss 2017) Many barriers to paramedics providing good end of life care eg lack of access to information/timely communication with appropriate teams (Brady 2014, Blackmore2020) 28.8% of inpatients in an acute hospital died within a year of discharge (Clarke et al 2014) Over 90% of hospital deaths occur following an acute admission Rising demand for unscheduled care (Mason et al 2020) 95% of those who died in 2016 had at least 1 contact with unscheduled care services (74% were SAS contacts) 50.4% had 6 or more contacts 5.4% had more than 20 contacts Increased contact as death approaches with 34.2% in last month Ongoing impact of pandemic uncertain Human factor… “The ferocity of this longing not to lose him obliterates, at times, both my training and my reason. I just do not want him to die...