Does paramedic intubation improve patient outcome?


And now for something completely differentThe second contribution to Spotlight on Research this month includes a summary of a research study which received one of the College of Paramedics' small grants for research: ‘A pilot study into the sensitivity and specificity of pre-hospital sepsis screening in the North East.’Researchers: Graham McClelland (North East Ambulance Service NHS Foundation Trust) and Jacqui Jones (South Tees NHS Hospitals Foundation Trust).Research question: How sensitive and specific is the pre-hospital sepsis screening tool (SST) used by North East Ambulance Service NHS Foundation Trust (NEAS) for detecting severe sepsis?Project aims: This project addressed the following aims:• 1. Estimate the sensitivity of the SST for detecting severe sepsis• 2. Estimate the specificity of the SST for detecting severe sepsis• 3. Explore the effect of paramedic detection and treatment of severe sepsis• 4. Inform the development of a larger, regional trial.We calculated the sensitivity and specificity of NEAS staff using the SST in practice which addressed aims 1 and 2. We changed the focus slightly as we realised that investigating the sensitivity and specificity of the SST was impractical in the sample we were able to collect. We also realised we were using the hospital SST as the gold standard to judge the pre-hospital SST against and as these are based on the same tool this would be meaningless. We documented the impact of NEAS detection of sepsis and NEAS pre-alerting for sepsis which addressed aim 3. Lessons have been learnt through the conduct of the project which can be used to continue this work on a larger scale, which would address aim 4.Results: The sample included 49 patients from January 2014. NEAS correctly identified 18/42 patients with sepsis (43% sensitivity, 14% specificity). NEAS correctly identified 8/27 patients with severe sepsis (30% sensitivity, 77% specificity). An issue was identified with the SST used in that NEAS staff don't have access to lactate or white cell count which are both included in the tool. Many patients were identified as having severe sepsis based on lactate measured at hospital.Conclusions: It is evident that NEAS clinicians diagnose sepsis without consistently using the SST. Triggering symptoms for sepsis and severe sepsis are documented but sepsis is not being recognised or documented. Point-of-care lactate may improve identification of severe sepsis.If you would like further information on this study, contact Graham McClelland, research paramedic, North East Ambulance Service NHS Trust on Graham. McClelland@neas.nhs.ukSpotlight on Research is edited by Julia Williams, principal lecturer, paramedic science, University of Hertfordshire, Hatfield, Hertfordshire, UK. To find out how you can contribute to future issues, please email her at j.williams@herts.ac.uk

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