Home is the preferred place of care for most palliative patients, and when they reach the end stage of their illness, their preferred place of death. But primary health care provision for this patient group is inconsistent and mostly provided by family, loved ones or residential care staff who feel unconfident in providing such care. These anxious carers often call emergency services for urgent help as they witness the worrying and unexpected symptoms of disease deterioration or dying, thus making paramedics and the ambulance service the patient’s first point of contact in primary care. An understanding is needed of the role of paramedics in palliative and end of life care and whether paramedic attendance is appropriate in this patient group.