This article first appeared at EMSWorld.com on Sept. 26, 2013.
It was nearly two decades ago that two paramedics with American Medical Response in Colorado Springs, CO, turned off the highway during a standard transport to fulfill the wish of a dying patient, and made the first of what would be many “sentimental journeys.”
Tawnya Silloway, community relations coordinator for AMR in Colorado Springs/El Paso County, relays the attending paramedic’s story of what happened that chilly autumn day:
“My partner was driving, and I was in the back with the patient,” he recalled. “He was very ill and wanted to go home for his last few days. I asked him if there was something I could do to make him more comfortable.
“He said he wanted to look at the aspens one more time.”
The driver veered off U.S. Highway 24 and drove the ambulance deep into the woods. She came to a stop in a clearing with an expansive view of the fall colors.
“At first we opened the back bay door of the ambulance, and he looked out and said, ‘Can we go out there and breathe the air?’”
They honored that request and sat with him for about an hour.
The patient had no interest in conversing, though, and when they tried to talk with him, the man advised them to “pay attention.”
“I finally got what he was getting at. Sure enough, you heard the birds, you saw the leaves rustling in the wind,” he said. “It changed my perspective completely. It was such a moving experience for my partner and I.”
With that, the “Sentimental Journey” program was born.
Creating the Program
This spur of the moment act of compassion made a deep impression on the crew, Silloway says, and they convinced AMR management and Hospice to implement it as a program.
As part of the program, AMR donates all the crew time, medical supervision and vehicle expenses required to take a hospice patient out to fulfill a final request. Silloway says there were a few obstacles to the idea such as liability, patient screening and possible patient death on a Journey, but all were resolved by communicating with the families, hospice staff and county coroner, and by providing palliative care training for the EMS crews.
In 1996, the American Ambulance Association honored the program, and Sentimental Journey has since been recognized by the National Association of Emergency Medical Technicians.
Silloway says the program has since spread within AMR and beyond, partly thanks to EMS speaker/author Steve Berry, who talks about it often and sends interested providers her way for more information. Berry was the paramedic on that first Journey, along with his partner Kim Madison.
Last year, AMR paramedics volunteered more than 200 hours to provide 18 Sentimental Journeys. The agency has done 13 journeys this year.
Going on a Sentimental Journey
Paramedics never know where they’ll be going, Silloway says.
They’ve been to the summit of Pikes Peak, the casinos of Cripple Creek and the chapel at the Air Force Academy. Other people don’t want an adventure, just a “normal” day at home.
Along the way, the paramedics have fulfilled some unusual requests. Silloway relays the story of one woman who wanted to go to Wal-Mart one last time:
“She went up and down the aisles buying stuff, and we thought this was an interesting last wish,” the paramedic said. So he asked her about it.
Come Christmas, she’d be dead, she told him. She wanted to make sure her grandchildren and others in her family would have gifts from her.
Silloway notes that it’s hard to say who gets more out of the experience—the patients and their families, or the EMTs and paramedics.
When she puts out a call for a Sentimental Journey, “It scares them a little in that it could be so sad, and then they come back and say, ‘That was one of the best things I’ve done in my EMS career,’” Silloway says.
“It may be one of the toughest but most rewarding calls you’ll ever run.”
How the Program Works
The program averages about two trips per month and is staffed entirely by volunteers from the local AMR operation, Silloway says. During the Journey, the crew is at the disposal of the patient. “If he wants to stop for ice cream, you stop for ice cream; if she wants to shop, you ask her where.”
The Hospice determines which patients are medically eligible to go on Journeys, and the outings can usually be handled at the basic level. Occasionally the patient will have IV pain control so a paramedic is needed.
Silloway says the “protocols” are a little different for a Journey if the patient starts to decline or passes away. “We make them as comfortable as possible, without invasive treatment,” she says. Although the program has never experienced a patient “death in the field” or “unattended death,” she says a protocol is in place and that any other agency interested in setting up a program must also prepare for this in advance. “In Colorado Springs we have a letter of understanding with the county coroner and if a patient passes during an SJ, we are able to transport back to the home or facility where we picked the patient up and hospice procedures take over from there.”
While a PCR is required on these trips, AMR does not bill for them; in the insurance information and the narrative it should be listed as “donated Sentimental Journey.”
Additional Benefits
For AMR, the initiative has proven to be an excellent community service program, Silloway notes. It has been recognized by the American Red Cross, the American Ambulance Association and the Southern Colorado Better Business Bureau. Recently, the Center for Nonprofit Excellence awarded AMR El Paso County with its 2007 Corporate Service Award after Pikes Peak Hospice nominated AMR for the award.
For the participating EMTs and paramedics, there are some more intangible benefits.
“This program has brought compassion back to EMS in this Community,” Silloway writes. “I hear stories almost weekly of crews going above the normal expected care to fulfill a small wish that is within their power.” Among those:
- taking a man home, and stopping by the cemetery for a few minutes to visit his wife’s grave
- going to the grocery store once a cupboard is discovered bare
- returning to the “scene” with a card and flowers for a elderly woman who just needs a friend
- just taking that extra couple minutes to hold a hand
AMR seeks to share the program guidelines, request sheet and any other information with any agency that would like to start a similar program in their area, Silloway says. She invites providers to contact her at Tawnya.Silloway@amr.net.