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More patients died in end-of-life care wards in areas without (54%) than with (33%) 24/7 home care services ( = 0.001). Integration of paramedics into end-of-life care at home is reasonable especially in rural areas without 24/7 palliative care services and outside of office hours. The majority of patients can be managed at home or with the help of an end-of-life care ward without an emergency visit. Integration of paramedics into end-of-life care at home is reasonable especially in rural areas without 24/7 palliative care services and