Nausea and vomiting can profoundly affect the quality of life for palliative patients. The prevalence of nausea and vomiting is high in this group, affecting 40-60% of all individuals receiving palliative care. Gastroparesis and chemical disturbances are the most common cause.
Establish goals of care in consultation and conversation with the patient, family, and care team.
Non-pharmacological interventions provide the best relief for mild and moderate nausea and vomiting.
Keep air and room fresh; eliminate strong odors.
Nausea and vomiting are separate, but related, phenomena that are present in many life-limiting conditions.
All palliative and end-of-life patients can be considered for inclusion in the Palliative Care Clinical Pathway (treat and refer) approach to care. Paramedics must complete required training prior to applying this pathway. Not authorized for EMRs or FRs.
Underlying causes can be classified into 6 broad groups:
Gastric stasis (impaired gastric emptying)
First Responder (FR) Interventions
Promote fresh air in the patient’s room and eliminate strong odors where possible
Promote non-pharmacological pain strategies such as positioning and reassurance
Emergency Medical Responder (EMR) & All License Levels Interventions
Establish goals of care in consultation and conversation with the patient, family, and care team
Complete a comprehensive nausea and vomiting assessment
Primary Care Paramedic (PCP) Interventions
Assist family with the administration of any medications that are recommended as part of an established care plan
Paramedics can only administer the patient’s own medications where the symptom management plan is clear, they are trained and experienced in the technique of administration, and are operating within BCEHS scope
Paramedics should consider patient’s existing regimen of drugs; ACPs may administer a patient's own prescribed medication only if the ACP has completed the appropriate Schedule 2 (4(b)) license endorsement