Patient Care

Develop a Sepsis Detection and Alert Program in Your EMS System

Issue 9 and Volume 41.

Like so many areas of medicine, sepsis detection, treatment and alerts have never really been on the EMS radar screen. But today, with innovative medical directors and EMS system leaders thinking outside the box, we’ve found ways to more easily assess for sepsis in the field, begin treatment early, and even call in sepsis alerts, allowing hospitals to shave crucial hours off the deadly sepsis timetable.

Sepsis shouldn’t only be on our radar screens, but be the prime target—the same way we approach critical traumas, strokes and ST elevation myocardial infarction.

Devastating Losses

Imagine if an EMS crew had detected that Muhammad Ali, one of the greatest athletes of all time and a national treasure, was becoming septic.

Imagine they were able to begin treatment in the field, helping doctors combat this deadly condition before it attacked his vital organs and eventually killed him.

Prehospital responders all over the world can and will be capable of doing this soon. Evidence shows that severe sepsis can be identified by a number of methods, and EMS providers have the ability to identify the hallmark hypoperfusion associated with sepsis and partner with hospitals to stop its deadly cycle of organ damage that leads to cardiovascular collapse and death.

The Centers for Disease Control and Prevention reports that there are more than 1 million cases of sepsis each year, and ranks it as the ninth leading cause of disease-related deaths.1 Those who do survive often face long-term and debilitating effects associated with both worsened cognitive and/or physical function.2

Sepsis also has a debilitating financial effect. It’s the most expensive in-hospital condition in the U.S., costing more than $17 billion each year in healthcare costs.3

Survivors often require readmission to the hospital, with more than 62% of patiets with a primary diagnosis of sepsis being readmitted within 30 days after discharge.4 Almost half of pediatric survivors of severe sepsis end up back in the hospital.5

Knocking Out Sepsis

Muhammad Ali’s tragic death reminds us that sepsis is often a fatal condition. However, it’s definitely a problem that we can impact with early assessment, identification and aggressive treatment via fluid resuscitation and medication administration.

This special JEMS section focuses on sepsis, including the assessment, detection and treatment of this life-threatening condition. Our authors cite the latest research and describe the innovative EMS protocols that marry SIRS and other helpful criteria to easily and reliably predict when patients have systemic infections and are prone to sepsis.

They also review multiple studies that have shown a relationship between low end-tidal carbon dioxide levels and dangerously elevated lactate levels that equate to acidosis and low-perfusion states.

Each article shows how the actions EMS takes from early sepsis assessment, detection and hospital alerting empowers EMS to save lives never before thought to be savable. Furthermore, hospitals will save time and money by countering sepsis before it advances to an irreversible state of septic shock.

This JEMS special focus on sepsis will be a game changer for prehospital medicine, empowering you and your agency to treat septic patients much earlier than ever before. Read each section carefully, share this valuable information with your medical director and receiving hospitals, and play a part in pioneering a new wave in EMS by working to develop a septic alert program in your community.

References

1. CDC. (Oct 5, 2015.) Sepsis fact sheet. Retrieved July 26, 2016, from www.cdc.gov/sepsis/pdfs/sepsis-fact-sheet.pdf.

2. Sepsis Alliance. (2016.) How large a problem is sepsis? Retrieved July 26, 2016 from www.sepsis.org/faq/problem.

3. Seymour CW, Rea TD, Khan JM, et al. Severe sepsis in prehospital emergency care: Analysis of incidence, care, and outcome. Am J Respir Crit Care Med. 2012;186(12):1264–1271.

4. Sutton JP, Friedman B. (Sept. 2013.) Trends in septicemia hospitalizations and readmissions in selected HCUP states, 2005 and 2010: Statistical brief #161. Healthcare Cost and Utilization Project. Retrieved July 26, 2016, from www.hcup-us.ahrq.gov/reports/statbriefs/sb161.pdf.

5. Czaja AS, Zimmerman JJ, Nathens AB. Readmission and late mortality after pediatric severe sepsis. Pediatrics. 2009;123(3):849–857.