References
Moving sepsis care to the front line: knowledge and views of pre-hospital clinicians
Abstract
Background:
Previous in-hospital studies have highlighted the opportunity pre-hospital clinicians have to recognise sepsis at an early stage. Left untreated, mortality in septic shock increases rapidly. Sepsis screening tools have been developed to assist recognition; however, current knowledge of sepsis, effectiveness of previous training and attitudes towards implementation of a screening tool is unknown.
Methods:
A survey was emailed to 529 paramedics and 131 advanced technicians in the North of England to determine their current knowledge of sepsis, views around previous training and the use of a screening tool. Case studies were included to investigate current management of patients with history of infection.
Results:
144 clinicians completed the survey, gaining a 21.8% response rate. 54% (95% CI 46%, 62%) of clinicians felt like they had good knowledge, leaving 46% of clinicians feeling a lack of knowledge. 94% (95% CI 89%, 97%) thought emergency departments should treat sepsis immediately or within the first hour. Case studies highlighted variability in the management pathways chosen and 98% (95% CI 94%, 99%) of clinicians required further training. 97% (95% CI 92%, 99%) agreed a screening tool would assist in the identification of septic patients and 98% (95% CI 95%, 99%) would use the tool.
Conclusions:
Severity level and importance of quick recognition and management are acknowledged among clinicians. Although response rate is a limitation of this study, knowledge levels differentiate greatly among the cohort and nearly all state they require further education. Clinicians agreed a screening tool would help identify septic patients and would use it alongside clinical acumen.
Sepsis has become a common condition. In a review of cases in England, Wales and Northern Ireland the treated incidence of severe sepsis in intensive care units per 100 000 population rose from 46 in 1996 to 66 in 2003, with the associated number of hospital deaths per 100 000 population rising from 23 to 30 (Harrison et al, 2006).
In an attempt to tackle this rise, the Surviving Sepsis Campaign (SSC) was launched in 2002 and updated successively with a primary focus on achieving a 25% reduction in the mortality of severe sepsis (Dellinger et al, 2004; Robson et al, 2009; Dellinger et al, 2013).
In-hospital early goal directed therapy (EGDT) has been evaluated in three multicentre studies (ARISE Investigators et al, 2014; ProCESS Investigators et al, 2014; Mouncey et, 2015), it has been demonstrated that there is no benefit of EGDT in comparison to usual care. It is important to note that though EGDT has shown to have no benefit, standard care has evolved where patients receive early recognition, fluid and antibiotic treatment routinely.
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