Background The role of the Emergency Medical Service (EMS) in End of Life (EOL) is often overlooked. The Gold Standards Framework Proactive Identification Guidance (GSFPIG) is an evidence-based screening tool to identify patients nearing EOL. We conducted a quantitative investigation using the GSFPIG to determine how often paramedics attend EOL patients with and without Advance Care Planning (ACP) in place followed by a qualitative interview study of paramedic perspectives on the usability and acceptability of the GSFPIG.

Methods A mixed methods explanatory sequential design was used. Thirty-five paramedics were recruited from one EMS in England. Paramedics were trained in study procedures and asked to apply the GSFPIG to every patient they attended, aged 65 and over, and to record EOL status and ACP presence. Data was analysed using descriptive statistics.

Ten paramedics were purposively selected for an individual interview to explore their experiences of using the GSFPIG and the concept of paramedics referring EOL patients to the GP to implement ACP. Framework analysis was used to analyse interview data.

Results Almost half (108/244;44.2%) of patients identified as EOL had no ACP in place. Where ACP was in place 37% of patients had a Do Not Attempt Resuscitation Order only, 50% a Recommended Summary Plan for Emergency Care or Treatment Escalation Plan and 13% unknown ACP type.

Analysis of ten paramedic interviews identified three key themes: Participant experiences of using the GSFPIG; Putting a screening and referral tool into practice; Paramedic views on ACPs.

Conclusion Paramedics are well placed to identify patients who would benefit from an ACP. The GSFPIG has utility in EMS and paramedics found it easy to use. Paramedics report that good quality ACP allows them to provide treatment and care in line with patient preferences.