Emergency Planning and Management

Emergency Planning and Management

What we know

A palliative care emergency is a sudden and life-threatening change in a person’s condition. In this scenario, handovers of care are particularly important to reduce risk of receiving inappropriate treatment. Planning ahead for possible emergencies is good practice and can improve the quality and safety of care. Documentation of care preferences or the nomination of a substitute decision-maker can help to ensure that a person receives care in line with their wishes.

What can I do?

Suggest that the family consider advance care planning. Planning for future care and Talking about goals, values, and preferences can help guide discussions and decisions around advance care planning.

Use this form (928kb pdf) to help you prepare and conduct a conversation with a GP when you are concerned about a resident’s health.

Remember that extended care paramedics and Nurse Practitioners may be able to provide care that could avoid a hospital admission.

When people decide to be cared for at home, ensure that they (person, family, carers) have a care plan which includes what to do in an emergency.

Make available the fact sheet about advance care planning for individuals (200kb pdf) and the factsheet for substitute decision-makers (200kb pdf) so that people in your care and their families can prepare for the future and document choices or preferences.

Advance care planning information can be uploaded to My Health Record.

Ensure that the Advance Care Plan (ACP) or Advance Care Directive (ACD) can be found quickly and easily. Make sure the contact details are up to date for the next-of-kin, the substitute decision-maker and the person to contact in case of an emergency; these may not be the same person.

When someone is transferred in an emergency, make sure that the current care plan and documents such as an ACD goes with them.  

After a health emergency or a hospital admissison, review the care plan. A family meeting may be helpful.

Remember that in NSW, ambulance services can provide care to older people in a Residential Aged Care Facilities (RACF) who have an Authorised Adult Palliative Care Plan (1.04MB pdf).
In SA, the extended care paramedic (ECP) service allows patients to be treated at home or in their home surrounds, without being transported to a hospital emergency department if it is not necessary. This includes older people with palliative care needs (1.19MB pdf).
In QLD, paramedic guidelines include palliative care (365kb pdf).

Support the person and their carers by letting them know about the Carer gateway Emergency care plan (481kb pdf) and other resources on Planning for emergencies.

Suggest that the person and their carers and family fill-out and print the palliAGED Emergency contacts form (84kb pdf) and leave it somewhere easy to find such as on the fridge.

Tell the person and their carers and family about the My Aged Care information on service continuity during an emergency event.


What can I learn?

Take the opportunity to update your skills on symptom management for respiratory distress, pain and gastrointestinal issues.

Reymond L, Cooper K, Parker D, Chapman M. End-of-life care: Proactive clinical management of older Australians in the community. Australian Family Physician. 2016;45:76-8

Burkett E, Scott I. CARE-PACT: A new paradigm of care for acutely unwell residents in aged care facilities. Australian Family Physician. 2015;44(4):204-9.

The policy on end-of-life and palliative care in the Emergency Department (557kb pdf) - Australasian College for Emergency Medicine (ACEM).

Read the factsheet about advance care planning for care workers (202kb pdf).

The general public, health care professionals, care workers and students can do modules available at ACP Learning - a website to support online learning for all those interested in learning more about advance care planning.

Check out the ACP Learning resource library.


What can my organisation do?

Recommend palliAGEDnurse for nurses working in residential, community or primary care.

Upskill staff to manage symptoms that might otherwise indicate the need for an acute care admission.

Prepare staff and services for the recognition of impeding death to avoid sense of emergency/panic if unprepared.

Consider developing an emergency care pathway that might reduce the need for acute care admissions. Review after-hours emergency procedures.

Prepare staff to be comfortable and confident with communication at a time of an emergency; they know how to pass on 'bad news' and are sensitive to how people may receive 'bad news'.

Train staff to introduce discussion around advance care planning and offer contact details of people who can provide assistance in completing the paperwork.

Ensure there is a process of integrating an Advance Care Plan (ACP) or Advance Care Directive (ACD) into notes/records and the goals of care.

Make sure that a copy of the ACD is readily available in notes or records; an electronic version may assist accessibility by various people and organisations which provide care.

Page updated 23 April 2020