Hospice patients have a terminal illness and have chosen comfort-focused care, yet families often call 911 when symptoms suddenly worsen. The responder checks advance directives, contacts the hospice team and relieves suffering in line with the patient's wishes.
Key symptoms
- Uncontrolled pain
- Shortness of breath or noisy breathing near death
- Agitation, restlessness or confusion
- Nausea, vomiting or no longer eating and drinking
- Family distress and uncertainty about what to do
What you find on exam
- Look for a DNR order, POLST or advance directive
- Vital signs only as far as they help comfort and decisions
- Breathing effort, secretions, skin color and mottling
- Pain and distress level, with a behavioral scale if nonverbal
- Reversible problems: urinary retention, constipation, injury from a fall
Tests
- Usually none; avoid tests that do not change comfort care
- Glucose if confused or diabetic
- Review the hospice comfort kit and doses already given
- Call the hospice nurse or medical control for guidance
Treatment basics
- Follow the documented wishes; contact hospice before deciding on transport
- Opioids such as morphine for pain and breathlessness
- Repositioning, gentle mouth suction, glycopyrrolate or atropine drops for secretions
- Haloperidol or lorazepam for agitation per protocol
- Support the family and explain the normal signs of dying
Red flags
- Severe pain or distress despite medicines
- No DNR or POLST on hand and the family unsure
- A new treatable problem the patient would want treated
Practice it in Making Synapses
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NCSBN 2026 NCLEX-RN Test Plan; NREMT psychomotor skill sheets (EMT and Paramedic). Written by Making Synapses. Making Synapses is not affiliated with these organizations.