{
  "abstract": "Aims and Objectives Ambulance services are increasingly central to end-of-life (EOL) care, yet national information on their activity, training, and clinical infrastructure remains limited. Mapping EOL provision across UK ambulance trusts provides insight into how services can better support dying patients and reduce avoidable hospital transfers.Method and Design Freedom of Information (FOI) requests were sent in 2025 to all 14 UK ambulance services (11 in England and one each in Wales, Scotland, and Northern Ireland). Questions explored service activity, palliative care support, access to anticipatory medications, EOL leadership, local guidance, and staff education.Results and Conclusion Reported caseloads varied substantially: one trust attended 33,752 adult EOL patients in 2024, of whom 61 % re-contacted the service and 45 % were conveyed to hospital; another reported 7,925 attendances, with 791 conveyed. All responding trusts had access to palliative advice, mainly by telephone or through regional hubs, available 24 hours daily. DNACPR documentation was accepted in multiple forms (e.g., RESPECT, local or hospital versions), and electronic access was available in all. Two services reported both Paramedic and Medical EOL Leads. Anticipatory medications could be accessed in several regions, usually through advanced paramedics or shared-care arrangements with local health trusts. All had guidance for supporting patients to remain at home or transfer to hospices. Training provision for EOL care was inconsistent—some offered induction modules and simulation, others relied on ad hoc online learning, with limited routine refresher training.Ambulance services play a vital role in pre-hospital EOL care but show wide variation in infrastructure, access, and education. A nationally coordinated approach, incorporating consistent training, clear guidance, and collaboration with palliative networks, could strengthen ambulance-based EOL support and promote dignified care in patients’ preferred settings.",
  "authors": [
    {
      "affiliations": [
        "Derby and Burton NHS Trust"
      ],
      "name": "Sarah Edwards"
    },
    {
      "affiliations": [
        "University Hospitals of Nottingham NHS Trust"
      ],
      "name": "Nicola Ubayasiri"
    },
    {
      "affiliations": [
        "Derby and Burton NHS Trust"
      ],
      "name": "Holly Wilkins"
    }
  ],
  "title": "4021 Dying in the ambulance: a national review of end-of-life care provision across UK ambulance services",
  "uid": "d540e695-97ce-52a5-962d-70a46bc870e5"
}