EMS plays a vital role in identification and early intervention of life threatening conditions. Most paramedic education programs provide ample training in prehospital care for cardiac arrest, and ST elevation myocardial infarction (STEMI), but little emphasis on prehospital identification or management of sepsis. In the last five years, there has been a push in the EMS community to provide better training to identify sepsis early and begin treatment quickly to help avoid a fatality. In South Carolina, the Greenville County EMS (GCEMS) began this process by evaluating the outcomes of severe sepsis patients. They found that on average EMS transports two to three patients with severe sepsis a day to local emergency departments in Greenville County.
Prehospital Intervention plays a vital role to a successful outcome
The GCEMS data found that it took on average up to 135 minutes to identify and treat a septic patient with antibiotics in the hospital. Data results showed that the sooner septic patients were given antibiotics, the better the outcome, with an 8 percent reduction in septic patients dying.
Researchers have found that EMS transports 34 percent of septic patients to the emergency department, and 60 percent of patients with severe sepsis. EMS play a critical role in reducing the time it takes to administer antibiotics to these patients, with early identification and treatment of these patients. This evidence prompted the GCEMS to work with two county hospital systems to develop new protocols for sepsis assessment and treatment and utilize criteria identified by researchers of the Surviving Sepsis Campaign, a nationwide project that began five years ago.
Under the new protocols, before the Greenville County EMS declare a sepsis alert to the emergency department, EMS providers determine if a patient presents with the following four criteria:
- Tachycardia (heart rate >90bpm)
- Tachypnea (respiratory rate > 20)
- Hyperthermia (body temperature >101 degrees F) or hypothermia (body temperature<96.8 F; and
- Signs of poor perfusion (systolic blood pressure<90 mm/Hg).
Once the sepsis alert has been sent to the emergency department, the goal of prehospital treatment is to support end organ perfusion and deliver a broad spectrum antibiotic. Prehospital blood specimens are collected by Greenville County EMS. Once this is done a broad-spectrum antibiotic is given along with up to two liters of normal saline patients once sepsis is identified.
Since November 2014, GCEMS has treated more than 650 patients using this sepsis alert protocol, and has seen the lowest levels of patient mortality in the hospital systems’ history, with a decreased length of stay for these patients and cost savings of close to $600,000.
Source: Journal of Emergency Medical Services, “South Carolina EMS Integrates In-Hospital Sepsis Care into Protocols” September 1, 2016
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