Sepsis: a need for prehospital intervention?

Abstract

Prehospital staff have made a significant contribution in recent years to improving care for patients with acute coronary syndrome, multiple trauma and stroke. There is, however, another group of patients that is not currently being targeted, with a similar time-critical condition. This group of patients is those with severe sepsis and septic shock and they could also benefit greatly from timely prehospital care. This article will consider how prehospital staff can improve the outcome of patients with severe sepsis, and in particular how they can aid emergency departments in identifying and initiating treatment in patients with severe sepsis.

An Early Warning Scoring System to Identify Septic Patients in the Prehospital Setting: The PRESEP Score

“…In contrast, the Robson screening tool and the BAS 90-30-90 were originally validated in a study cohort consisting only of septic patients. 3,4 Sepsis is considered an emergency condition that requires early recognition and treatment. EMS systems already play a key role in the management of other conditions that benefit from rapid detection and therapy, such as acute cardiovascular disease, stroke, and trauma.…”

“…BAS 90-30-90 = acronym for sBP < 90 mm Hg; respiratory rate (Swedish: "Andningsfrekvens") > 30 breaths/min; SaO 2 < 90% 4 ; NPV = negative predictive value; PPV = positive predictive value; MEWS = modified early warning score 2 ; PRESEP = Prehospital Early Sepsis Detection; Modified Robson Screening Tool = altered mental state presented by GCS < 15. 3 …”

“…The Modified Early Warning Score (MEWS) is a diseasenonspecific scoring system validated in hospitalized patients to detect risk of severe deterioration. 2 The Robson screening tool 3 and the BAS 90-30-90 4 (details in Data Supplement S1, available as supporting information in the online version of this paper) were specifically developed to detect sepsis in the out-of-hospital setting. A recent comparison of both previously unvalidated tools found that the Robson screening tool was more sensitive than the BAS 90-30-90 or clinical judgment.…”

Diagnostic Characteristics of a Clinical Screening Tool in Combination With Measuring Bedside Lactate Level in Emergency Department Patients With Suspected Sepsis

“…13 At the time of triage, the ED triage nurse indicated whether infection was suspected on a specific field in the electronic triage form. If this box was checked and the patient had at least two of the criteria for systemic inflammatory response syndrome (SIRS) as indicated above, an electronic message was sent to the research staff who then approached the patient and verified study criteria.…”

Early Detection and Treatment of Patients with Severe Sepsis by Prehospital Personnel

“…Similarly, decreased door-to-balloon times have been demonstrated in ST segment elevation myocardial infarction patients by using prehospital electrocardiograms (10,11). A need for increased awareness and more aggressive treatment in the out-of-hospital setting has been recommended previously, and a prehospital severe sepsis screening tool based on consensus definitions has been developed, but not tested (5,12).…”