#143 Deciding place of care: Advance Care Planning decision making with paramedic Tom Pullen

Have you ever wondered about the complexity of Advance Care Planning in a critical situation? This episode expands the theme of “decision to treat at home”, with paramedic Tom Pullen. It’s a case study in which Tom shares the nuance of decision making.

Key messages

• The episode explores the complexity of Advance Care Planning in emergency situations.

• Through case study discussion, paramedic Tom Pullen details the decision-making process for treating an elderly patient suspected of having a stroke at home.

• We talk about the importance of family and aLasting Power of Attorney (LPA) in healthcare decisions.

• The challenges of balancing patient wishes with clinical safety and best outcomes are explored.

• The value of open, honest, and compassionate communication between professionals and families is highlighted.

• There is a  need for clear conversations about the role and responsibilities of a Lasting Power of Attorney well before a crisis occurs.

• Reflection on the limits of attributing "right" or "wrong" to challenging decisions - each situation is unique and must be person-centred.

• Tom shares the benefits and risks of hospital admission versus urgent community response and care at home.

• We discuss keeping the patient at the heart of all planning and decisions.

• Talking with Tom highlights the complexity, nuance, and essential ‘messiness’ of Advance Care Planning, and the ongoing need for professional self-reflection.

Resource

• Decision to treat at home with paramedic Tom Pullen 

• My Future Care Handbook

  
  

Bio

Tom is an Advanced Clinical Practitioner working in Urgent Community Response with Sussex Community NHS Foundation Trust, and a Practice Development Lead with South East Coast Ambulance Service. With a background as a paramedic, Tom has built his career across urgent and emergency care, helping to shape services that enable patients to receive high-quality care in the most appropriate setting. He is passionate about how language, culture, and mindset influence clinical decision-making - particularly around the concept of a “decision to treat at home.” Tom is dedicated to advancing clinical practice, supporting colleagues in their development, and improving patient-centred care across both ambulance and community services.