New research reveals how to better support Māori in out-of-hospital deaths

New research highlights opportunities for emergency ambulance services to better support Māori whānau during out-of-hospital deaths, particularly in responding to cultural, spiritual and collective whānau needs at the end of life.

Each year, emergency ambulance services attend more than 6,000 out-of-hospital deaths across Aotearoa, New Zealand. In these moments, ambulance personnel are responsible not only for urgent clinical care, but also for supporting whānau experiencing sudden loss and immediate bereavement.

'Experiences of Bereaved Māori Whānau in Out-of-Hospital Death Where Emergency Ambulance Services Respond', published in 'Kōtuitui: New Zealand Journal of Social Sciences Online', explores the lived experiences of bereaved Māori whānau when emergency ambulance services respond to deaths in homes and community settings.

Led by researchers from the University of Auckland School of Nursing, the qualitative study uses kaupapa Māori research principles and centres whānau voices to better understand what matters most during moments of death, dying and immediate bereavement.

The research forms part of lead author and Nursing Lecturer Eillish Satchell’s PhD, which was supported by a Health Research Council Māori Clinical Research Training Fellowship, that she completed this month. The study also contributes to a wider body of work by the Te Ārai Palliative Care & End of Life Research Group examining family experiences of death and dying across Aotearoa.

Satchell (Ngāpuhi) says the findings show that while clinical care is often provided effectively, cultural care is experienced as inconsistent.

“For many Māori whānau, death is not just a medical event - it’s a deeply spiritual transition that requires time, space and collective presence,” she says. “Our research shows whānau are often left to uphold tikanga on their own, without adequate recognition or support from emergency services.”

Whānau, tikanga and presence matter

Māori experience higher rates of out-of-hospital cardiac arrest and are less likely to survive these events, meaning whānau are disproportionately exposed to sudden death in emergency settings. Ambulance personnel are frequently the only healthcare professionals present, placing them in a pivotal role at an especially vulnerable time.

Satchell’s doctoral research consisted of interviews with 23 bereaved family members who were present during out of hospital death where emergency ambulance services responded.

Through in-depth interviews with Māori whānau, the study identified four key themes shaping whānau experiences:
• Whānau kotahitanga – the importance of unity and collective decision-making
• The role of tikanga during death and bereavement
• Death as a spiritual transition, rather than an endpoint
• The positive impact of Māori emergency responders

Co-author Senior Research Fellow Dr Tess Moeke-Maxwell (Ngāi Tai, Ngāti Porou) says the research highlights how Western emergency models can clash with Māori worldviews.

“Tikanga during death and dying isn’t an ‘add-on’ - it’s fundamental to Māori wellbeing,” she says. “When systems prioritise speed and protocol over whānau presence and cultural practices, it can deepen trauma and disrupt the grieving process.”

Whānau described the importance of being present at the moment of death, caring for the tūpāpaku, performing karakia, and ensuring dignity - practices that are often constrained by emergency or coronial procedures.

Culturally safe care benefits everyone

The study consistently found that whānau experiences improved when Māori emergency responders were present, including paramedics, police, fire personnel and funeral directors. These responders were more likely to recognise tikanga, ask about cultural needs and provide care that felt safe and respectful. Co-author Dr Natalie Anderson, Senior Lecturer from the University of Auckland and emergency nurse at Te Toka Tumai – Health New Zealand, says this places an unfair burden on Māori staff.

“Māori emergency responders are often expected to carry the responsibility for cultural safety,” Anderson says. “But culturally safe care must be a shared responsibility across the entire workforce - it can’t rely on who happens to be on shift.”

The researchers say strengthening cultural safety education, embedding Indigenous care frameworks and increasing Māori representation within the paramedicine workforce are key opportunities for improvement.

Implications for emergency services

The study adds to growing evidence calling for a more holistic, culturally safe approach to emergency and bereavement care - one that acknowledges whānau as central, honours Māori spiritual beliefs, and balances clinical urgency with human need.
The research team is currently undertaking further work focused on improving emergency responses to death and dying, including the development of simulation-based training for paramedics that incorporates end-of-life and bereavement scenarios.

New findings from this work were published this week and are part of a wider programme of research shared through the Te Ārai blog.

“When we get care right for Māori whānau - not just in death, but at all times,” Satchell says, “we improve care for everyone.”