Severe sepsis and septic shock in pre-hospital emergency medicine: survey results of medical directors of emergency medical services concerning antibiotics, blood cultures and algorithms

Abstract

Delayed antibiotic treatment for patients in severe sepsis and septic shock decreases the probability of survival. In this survey, medical directors of different emergency medical services (EMS) in Germany were asked if they are prepared for pre-hospital sepsis therapy with antibiotics or special algorithms to evaluate the individual preparations of the different rescue areas for the treatment of patients with this infectious disease. The objective of the survey was to obtain a general picture of the current status of the EMS with respect to rapid antibiotic treatment for sepsis. A total of 166 medical directors were invited to complete a short survey on behalf of the different rescue service districts in Germany via an electronic cover letter. Of the rescue districts, 25.6 % (n = 20) stated that they keep antibiotics on EMS vehicles. In addition, 2.6 % carry blood cultures on the vehicles. The most common antibiotic is ceftriaxone (third generation cephalosporin). In total, 8 (10.3 %) rescue districts use an algorithm for patients with sepsis, severe sepsis or septic shock. Although the German EMS is an emergency physician-based rescue system, special opportunities in the form of antibiotics on emergency physician vehicles are missing. Simultaneously, only 10.3 % of the rescue districts use a special algorithm for sepsis therapy. Sepsis, severe sepsis and septic shock do not appear to be prioritized as highly as these deadly diseases should be in the pre-hospital setting.

Construction of multifunctional porcine acellular dermal matrix hydrogel blended with vancomycin for hemorrhage control, antibacterial action, and tissue repair in infected trauma wounds

“…In addition, they often bring inevitable side-effects such as high rebleeding rates (HemCon) [ 4 ] and tissue thermal damage (Quikclot) [ 5 ], which severely limit their further application. Moreover, wounds exposed to a polluted environment are prone to bacterial infection [ [7] , [8] , [9] ], which can hinder the healing process and cause life-threatening complications including sepsis, severe sepsis, and septic shock [ 10 , 11 ]. Nevertheless, bacterial infection receives relatively less focus in the treatment stage prior to hospitalization than hemorrhage [ 11 ].…”

“…Moreover, wounds exposed to a polluted environment are prone to bacterial infection [ [7] , [8] , [9] ], which can hinder the healing process and cause life-threatening complications including sepsis, severe sepsis, and septic shock [ 10 , 11 ]. Nevertheless, bacterial infection receives relatively less focus in the treatment stage prior to hospitalization than hemorrhage [ 11 ]. Thus, treatment before hospitalization faces the dual challenges of controlling bleeding and preventing microbial infection.…”

If you don’t take a temperature, you can’t find a fever

“…There could be a change in management with oxygen, infusion therapy, and transportation management and handover procedure in relation to time management and destination hospital. However, in Germany, there are only a few rescue districts with rescue vehicles carrying antibiotics with them in the prehospital setting, so the therapeutic consequence in prehospital antibiotic treatment does not seem to be realistic, at least not yet [12].…”

“…Regardless of discussions about the best sepsis screening tool in the prehospi- [12]. Recently, sepsis has been included as one of the six time-critical tracer diagnoses, thus requiring EMS to foster stronger awareness in the prehospital setting [13].…”

Sepsis in der prähospitalen Notfallmedizin

“…Die Gewinnung mikrobiologischer Proben ist im Rettungsdienst prinzipiell möglich [ 49 ], setzt jedoch streng sterile Bedingungen voraus. Als weiteres Problem werden beispielsweise Blutkulturen nur in 2,6 % der Rettungsdienstbereiche überhaupt vorgehalten [ 11 ] und die prähospital genutzten Produkte könnten möglicherweise nicht mit denen der Klinik übereinstimmen und damit das weitere prozedurale Verfahren beeinflussen. Dies schränkt die Fokussuche (Tab.…”