Ep4: Goal-Concordant Care in EMS

In this episode of the EMS Clinical Brief, host Maia Dorsett interviews Amelia Breyre, an emergency physician, EMS physician, and EMS Medical Director for the City and County of San Francisco who is nationally recognized for her expertise in prehospital palliative care and advance care planning. Together they explore how EMS clinicians can provide goal-concordant care by understanding advance care planning documents, including advance directives, health care proxies, and POLST/MOLST forms. They discuss how to interpret these documents, distinguish legal documents from actionable medical orders, navigate challenging situations involving limited interventions, and develop practical communication skills to clarify patient goals before initiating invasive treatments. The episode emphasizes that one of EMS's most important roles is not simply delivering medical interventions, but ensuring that the care provided aligns with what the patient would have wanted.CAPCE-accredited CME Available @Prodigy EMS: https://frontend.prodigyems.com/class/511A0F86-3B25-4A57-8D2E-91F1B9F26F76?tab=overviewReferences:1.Breyre, A. M., Sporer, K. A., Davenport, G., Isaacs, E., & Glomb, N. W. (2022). Paramedic use of the Physician Order for Life-Sustaining Treatment (POLST) for medical intervention and transportation decisions. BMC Emergency Medicine, 22(1), 145.2. Breyre, A. M., Merkle-Scotland, E. J., Yang, D. H., Hanson, K., Jagani, S., Tolkoff, A., & Gunaga, S. (2025). Do not resuscitate (DNR) emergency medical services (EMS) protocol variation in the United States. The American journal of emergency medicine.3.Breyre, Amelia M., Haley Vertelney, Karl A. Sporer, Glen Davenport, Eric D. Issacs, and Nicolaus W. Glomb. "Emergency medical service interpretation of Physician Orders for Life‐Sustaining Treatment (POLST) in cardiopulmonary arrest." Journal of the American College of Emergency Physicians Open 3, no. 2 (2022): e12705.