Prehospital sepsis care: Understanding provider knowledge, behaviors, and attitudes

Polito, Carmen; Bloom, Ingrid; Yancey, Arthur; Lairet, Julio; Isakov, Alexander; Martin, Greg S.; Rajasekar, Saranya; Patel, Anjni; Murphy, David J.; Sevransky, Jonathan

doi:10.1016/j.ajem.2016.10.074

Cited by 7 publications

(5 citation statements)

References 5 publications

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“…In the present study, the sepsis identification rate of the EMS clinicians, as documented in the patients’ electronic health records, was found to be low. This result corresponds with those of previous studies regarding the EMS clinician assessments of patients with sepsis and severe sepsis [1, 6, 8, 20, 31]. Additionally, our study also compared the EMS sepsis identification rate in relation to the patient outcomes.…”

Section: Discussionsupporting

confidence: 89%

“…For example, lower oxygen saturations were related to adverse outcomes in patients with sepsis in this study. A lower oxygen saturation is known to be an important vital sign in patients developing severe sepsis [8, 11, 21], and it has been used as a comarker in several screening tools, such as BAS 90–30-90 and PRESS score [8, 11]. Still, when investigating whether a oxygen saturation < 90% could predict a development of adverse outcome, there was no clear likelihood of this.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 50 to 75% of the patients with sepsis are cared for and transported to emergency departments (EDs) by the EMS [5–7]. Unfortunately, these patients have a high in-hospital mortality rate [1, 5–7] and relatively few patients (only 6 to 36%) are suspected of having sepsis by EMS clinicians in the prehospital field [1, 6, 8, 9]. However, the clinical presentation of sepsis is often nonspecific [10], making early identification difficult [11], which may lead to delayed treatment and a worse prognosis.…”

Section: Introductionmentioning

confidence: 99%

“…These results indicate that a documented suspicion by the EMS are important for time to treatment in patients with sepsis. Prehospital screening tools for the identification of patients with sepsis and/or severe sepsis include the PREhospital Severe Sepsis (PRESS) score, Robson screening tool, Sepsis Alert protocol, quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and BAS 90–30-90 (based on the oxygen saturation, respiratory rate and systolic blood pressure) [8, 14, 18–20]. Despite the prehospital screening tools and treatment guidelines that are available, there is still extensive patient morbidity and mortality due to sepsis [14].…”

Section: Introductionmentioning

confidence: 99%

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Prehospital characteristics among patients with sepsis: a comparison between patients with or without adverse outcome

et al. 2019

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Background The prehospital care of patients with sepsis are commonly performed by the emergency medical services. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients with sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse prognosis. Therefore, early identification of patients with sepsis is important, and more information about the prehospital characteristics that can be used to identify these patients is needed. Based on this lack of information, the objectives of this study were to investigate the prehospital characteristics that are identified while patients with sepsis are being transported to the hospital by the emergency medical services, and to compare these values to those of the patients with and without adverse outcomes during their hospital stays. Methods This was a retrospective observational study. The patients’ electronic health records were reviewed and selected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an emergency department by the emergency medical services. Data were collected on demographics, prehospital characteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit, and analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital characteristics for predicting or development of adverse outcome were analysed. Results In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing patients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care were found to be associated with an adverse outcome. Conclusions The findings suggests that patients having a decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient prognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with sepsis early and improve their long-term outcomes. However further research is required to predict limit values of saturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients with sepsis. Electronic supplementary material The online version of this article (10.1186/s12873-019-0255-0) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prehospital characteristics among patients with sepsis: a comparison between patients with or without adverse outcome

et al. 2019

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“…[410] Other paper in the US showed that 24% of EMS providers were unaware of the effect of early recognition and management on morbidity and mortality rates. [11]…”

Section: Introductionmentioning

confidence: 99%

Understanding the knowledge and attitude of prehospital sepsis care among emergency medical service personnel

Ghazal

Alkhunein

Alkhazi

et al. 2019

J Emerg Trauma Shock

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Background: Sepsis represents a huge burden for the health-care system. Septic patients presented by emergency medical services (EMS) are usually sicker in comparison to patients arriving by other means. Knowledge of sepsis is a key factor in recognizing and providing the appropriate care; it is not the only barrier as EMS providers do not have access to the proper diagnostic investigation. This work highlighted the level of knowledge, awareness, and attitude of EMS providers regarding prehospital care of sepsis in Riyadh, Saudi Arabia. Methods: This study was a cross-sectional study that conducted among EMS personnel of Saudi Red Crescent Authority and King Abdulaziz Medical City. One hundred and ninety-seven individuals were sampled (99 were technicians and 98 were paramedics). Results: Most participants (71%) were aware of the term “sepsis;” however, only 48% of participants correctly defined sepsis (30% between emergency medical technicians [EMTs] vs. 66% paramedics group, P < 0.01). Paramedics were noted to have a better understanding of signs, symptoms, and management of sepsis. Most of the participants thought that sepsis can be identified during prehospital care (55%) and 75% suggested that they should be involved in the management of septic patients. About 80% responded that their intervention would result in a better outcome for patients and would influence the behavior of emergency department medical care. Most of the participants (83%) were willing to be actively engaged in the prehospital care of septic patients. Conclusion: This study showed an insufficient level of knowledge and awareness regarding sepsis care in the EMS field in Saudi Arabia. Paramedics had more knowledge and awareness about sepsis care compared to EMT personnel. Future work should focus on exploring the reasons behind this, as well as implementing plans to improve education about sepsis for EMS personnel.

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Sepsis erkennen im Rettungsdienst

Metelmann

Scheer

et al. 2018

Anaesthesist

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Although emergency personnel rated an early initiation of sepsis treatment as important, sepsis knowledge was limited. While the majority of emergency doctors and many nurses had attended educational programs on sepsis within the last year, an alarmingly high percentage of paramedics and emergency dispatchers had never received sepsis education. Emergency personnel are mostly unfamiliar with the qSOFA score and did not associate an altered mental status with sepsis. In light of the high sepsis morbidity and mortality, further achievements might be made by initiating sepsis screening and diagnostics in the prehospital setting. Analogous to advancements in intensive care units, increased educational programs for emergency personnel might lead to an earlier detection and improved prognosis of sepsis.

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Prehospital sepsis care: Understanding provider knowledge, behaviors, and attitudes

Cited by 7 publications

References 5 publications

Prehospital characteristics among patients with sepsis: a comparison between patients with or without adverse outcome

Prehospital characteristics among patients with sepsis: a comparison between patients with or without adverse outcome

Understanding the knowledge and attitude of prehospital sepsis care among emergency medical service personnel

Sepsis erkennen im Rettungsdienst

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