References
Prehospital sepsis care in Ireland: an audit
Abstract
Background:
Sepsis is a life-threatening illness that requires early recognition and treatment. In Ireland, mortality, while improving, remains at 17% for adults and in a range of 2–4% in children aged under16 years. Prompt, accurate recognition of severe sepsis in the prehospital period could improve outcomes in patients with severe sepsis.
Aim:
This study aimed to audit the prehospital care of patients with sepsis against national Irish sepsis clinical practice guidelines and identify areas for improvement.
Methods:
A retrospective analysis of all Dublin Fire Brigade patient care reports over a 1-week period was carried out and patients with potential sepsis and potential severe sepsis were identified. Care was assessed against the national prehospital clinical practice guidelines. Call-taking and dispatch information were cross-checked.
Findings:
The incidence of potential sepsis was 3.7%. It is a condition of extremes of age; 8.5% of patients were aged less than 1 year and 58% were aged above 65 years. While 48% of calls were categorised as high priority, about one-third (32%) were put in a low-priority category, and 37% of the latter were potential cases of severe sepsis. The most common chief complaints at the call-taking stage were ‘breathing problems’ and ‘sick person’.
Conclusion:
Potential sepsis is not infrequent and call-taking information may not capture the potential or severity of sepsis. Education must emphasise the risk in old and young patients. To ensure patients receive timely advanced interventions, call-taking and dispatch systems should ensure that practitioners with the skills to identify and manage sepsis are dispatched to these patients.
Sepsis is a time-sensitive illness with high morbidity and mortality rates. It has received global recognition and prioritisation over the past 15 years. Medical and governmental bodies have recognised the serious consequences of sepsis (Dellinger et al, 2013). In Ireland, mortality, while improving, still stands at 17% for adults and is in a range of 2–4% in children aged under 16 years (Health Service Executive, 2017). Mortality rates in the United States are similar at 14.5% (Paoli et al, 2018). In the UK, an all-party parliamentary group established a confidential enquiry into sepsis, which concluded that the care of two out of three people with sepsis could be improved (National Confidential Enquiry into Patient Outcome and Death (NCEPOD), 2015).
Emergency medical services (EMS) personnel are often the first point of medical care for patients with severe sepsis (Wang et al, 2010), and they influence the type of care patients receive and when they receive it.
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