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TWO STUDIES EXAMINING PREHOSPITAL PROVIDER SEPSIS IDENTIFICATION AND TREATMENT
STUDY 1: Summary of Severe Sepsis in Pre-Hospital Emergency Care; analysis of incidence, care and outcome, was published December 2012 in the American Journal of Respiratory and Critical Care Medicine and is Reprinted with permission of the American Thoracic Society. Copyright © 2013 American Thoracic Society.
1. Why is this topic important? Severe sepsis is lethal and with its relatively high incidence of 3.3 per 1000 population; it is estimated that approximately 20% of cases die each year. EMS providers already transport and manage care for severe sepsis patients seen in the emergency department, yet there is no similar system of care for severe sepsis patient as exists for heart attack and stroke. Improved care and survival for the severe sepsis patient has been shown to be time sensitive, just as it is for the heart attack and stroke patient.
2. What does this study attempt to show? What is the incidence of severe sepsis patients transported to the emergency department by EMS between 2000 and 2009 in a large county in Washington State? What is the burden of severe sepsis on the EMS system compared with MI and stroke over the ten year time frame? What opportunities can be identified for severe sepsis recognition in the prehospital arena?
3. What are key findings? EMS providers transported up to 40% of all severe sepsis hospitalizations in the emergency departments of the study area. Most severe sepsis patients were diagnosed on admission; prehospital interventions including intravenous access were uncommon, despite mean on scene times of 35 minutes. The time EMS providers spend with their patients would provide an increased opportunity for EMS to recognize and potentially treat severe sepsis before arrival. One-half of these patients were admitted to an intensive care unit, and the total number of deaths in the EMS population attributed to severe sepsis was 19.6%. This was nearly double the deaths of EMS encounters with AMI or stroke.
4. How is patient care impacted? EMS provides care for a large number of patients diagnosed with severe sepsis and this patient population is growing. EMS is positioned well to recognize patients with severe sepsis and initiate critical, evidence-based interventions prior to hospital arrival. In order to recognize severe sepsis and begin treatment, there is a need for accurate recognition of severe sepsis by emergency medical providers.
STUDY 2: Early detection and treatment of patients with severe sepsis by prehospital personnel has been published online by the Journal of Emergency Medicine on January 13, 2013. Centura Health Prehospital Emergency Services-South Denver Group conducted this pilot study.
1. Why is this topic important? Severe Sepsis is a common medical problem presenting to the Emergency Department and the majority of these patients are first seen by Emergency Medical Services. The mortality of severe sepsis patients remains high despite well-established treatment protocols.
2. What does this study attempt to show? Can Emergency Medical Service providers identify patients with severe sepsis I the prehospital setting? Once identified does mortality change if the receiving Emergency department is notified before arrival and prehospital treatment is begun before arriving to the Emergency Department?
3. What are the key findings? Using a sepsis alert tool including subjective information, physiologic data, and prehospital lactate measurements Emergency Medical Services providers were able to identify patients with severe sepsis with an accuracy of 48%. Severe sepsis patients correctly identified by Emergency Medical Services had a mortality of 13.6% compared with 26.7% (p = 0.04) for all prehospital sepsis patients.
4. How is patient care impacted? The mortality of severe sepsis patients can be significantly decreased if these patients can be accurately identified by Emergency Medical Services personnel, the receiving hospital is notified before their arrival, and treatment is begun in the most proximal phase of their illness.