References
Can paramedics treat sepsis?
Abstract
Background:
Sepsis is the most common time-critical medical emergency attended by UK paramedics but lacks the pre-hospital treatment options available for other common conditions. Sepsis treatment is simple, effective and quick to deliver and frontline paramedics may be able to significantly improve patient outcomes if empowered to recognise and treat sepsis.
Methods:
The Isle of Wight (IOW) Pre-hospital Piperacillin/Tazobactam (PrePip) project tested the concept that paramedics could accurately recognise and safely treat sepsis in the pre-hospital environment. By selecting two high-risk patient groups and developing new patient group directives and protocols for paramedic antibiotic delivery IOW sepsis treatment was radically altered to focus on early pre-hospital care.
Results:
The project showed that paramedics were highly effective in recognising sepsis in clearly defined patient groups with their diagnosis of sepsis being corroborated by in-patient consultants in 93% of cases. Paramedic-delivered interventions such as collection of blood cultures and administration of IV fluid and broad-spectrum IV antibiotics were shown to be both safe and timely.
Conclusions:
This project suggests that a new ‘call-to-needle’ paradigm of sepsis treatment may be possible, with UK paramedics providing key elements of the Sepsis Six before reaching the emergency department. This may have significant implications for restructuring sepsis services.
Sepsis kills between 36 000 and 64 000 people in the UK every year (Daniels, 2011), with a prevalence ranging from 1–3 per 1 000 population, increasing in rate over the last two decades (Seymour et al, 2010). Severe sepsis with hypotension has a rapidly evolving negative clinical course with mortality increasing by 7.6% for every hour's delay in the administration of antibiotics (Kumar et al, 2006). These patients have an episode mortality of around 31% (Daniels, 2011) but lack the clear, rapid and carefully audited pre-hospital pathways successfully developed in recent years for other critical conditions such as myocardial inraction (MI) and stroke (Wang et al, 2010)
Early sepsis treatment is both simple and effective (Daniels, 2011; Ferrer et al, 2014 among others). Delivering a bundle of early interventions (The Sepsis Six—Box 1) can significantly improve survival (Seymour et al, 2012; Rivers et al, 2012; Ferrer et al, 2014). Improving the recognition of sepsis and rapid delivery of these life-saving interventions has the potential to dramatically improve morbidity and mortality (Rivers et al, 2001; Nguyen et al, 2007; Boardman et al, 2009; Siddiqui et al, 2009; MacRedmond et al, 2010; Gaieski et al, 2010; Rivers et al, 2012). Despite these dramatic figures, however, it has so far proved frustratingly difficult to significantly improve timings for in-hospital sepsis treatment.
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