References

Bakker J, Nijsten MWN, Jansen TC Clinical use of lactate monitoring in critically ill patients. Ann Intensive Care. 2013; 3:(1)

Browning R, Datta D, Gray AJ, Graham C Peripheral venous and arterial lactate agreement in septic patients in the Emergency Department: a pilot study. Eur J Emerg Med. 2014; 21:(2)139-41

Daniels R Surviving the first hours in sepsis: getting the basics right (an intensivist's perspective). J Antimicrob Chemother. 2011; 66:ii11-23

Dellinger RP, Levy MM, Carlet JM Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008; 34:(1)17-60

Dellinger RP, Levy MM, Rhodes A Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock. Crit Care Med. 2012; 41:(2)580-637

Erwin A, Salzman J, Wewerka S, Burnett A, Frascone RJ Can paramedics accurately diagnose sepsis and severe sepsis in the field?. Acad Emerg Med. 2011; 18:S23-4

Gray A, Ward K, Lees F, Dewar C, Dickie S, McGuffie C The epidemiology of adults with severe sepsis and septic shock in Scottish emergency departments. Emerg Med J. 2013; 30:(5)397-401

Groenewoudt M, Roest AA, Leijten FM, Stassen PM Septic patients arriving with emergency medical services: a seriously ill population. Eur J Emerg Med. 2014; 21:(5)330-5

Guerra WF, Mayfield TR, Meyers MS, Clouatre AE, Riccio JC Early detection and treatment of patients with severe sepsis by prehospital personnel. J Emerg Med. 2013; 44:(6)1116-25

Hokanson J, Boland L, Olson T, Fernstrom K, Lick C Use of lactate meters and temporal artery thermometers by paramedics to aid in the out-of-hospital recognition of sepsis: A pilot study. Ann Emerg Med. 2012; 60:(4)

Jansen TC, van Bommel J, Mulder PG, Rommes JH, Schieveld SJM, Bakker J The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study. Crit Care. 2008; 12:(6)

McClelland G, Younger P, Byers S Lactate measurement in pre-hospital care: a review of the literature. Journal of Paramedic Practice. 2012; 4:(6)329-34

McClelland G, Younger P A study into pre-alerts to North East hospitals for sepsis. Journal of Paramedic Practice. 2013; 5:(7)408-15

Mullen M, Cerri G, Murray R Use of point-of-care lactate in the prehospital aeromedical environment. Prehosp Disaster Med. 2014; 29:(1)1-4

Seymour CW, Rea TD, Kahn JM, Walkey AJ, Yealy DM, Angus DC Severe sepsis in pre-hospital emergency care: analysis of incidence, care and outcome. Am J Respir Crit Care Med. 2012; 186:(12)1264-71

Studnek JR, Artho MR, Garner CL, Jones AE The impact of emergency medical services on the ED care of severe sepsis. Am J Emerg Med. 2012; 30:(1)51-6

Thomas J Analysing Thurstone and Likert scales as data collection methods. Journal of Paramedic Practice. 2011; 3:(5)250-4

Tobias AZ, Guyette FX, Seymour CW Preresuscitation lactate and hospital mortality in prehospital patients. Prehosp Emerg Care. 2014; 18:(3)321-7

respiratory
trauma
pre-hospital

Evaluation of pre-hospital point-of-care testing for lactate in sepsis and trauma patients

02 October 2014
Features
02 October 2014
Volume 6 · Issue 10

Abstract

Objective: Lactate is a significant marker of critical illness and mortality in sepsis and trauma patients. The purpose of this study is to evaluate point-of-care lactate testing by paramedics in a UK ambulance service.

Methods: Selected enhanced care paramedics were trained to use the lactate meter in patients with suspected sepsis and patients who trigger the major trauma bypass protocol. Feedback was collected on the practicalities of using the meter and the potential impact on the diagnosis of sepsis.

Results: Data were collected on 114 patients, 96% had suspected sepsis (n=109) and 4% (n=5) were patients who had sustained trauma. The participants found that the ability to take lactate readings was useful and increased their confidence in their clinical decision making.

Conclusions: Point-of-care lactate measurement is feasible in pre-hospital care and appears to support paramedics in their decision making.

North East Ambulance Service NHS Foundation Trust (NEAS) covers the north east of England and employs around 1 000 accident and emergency staff across 57 locations who serve a population of 2.6 million people.

As part of the NEAS drive to improve patient care, a sepsis screening tool (SST) was introduced into practice in April 2012 (Figure 1) based on the recommendations of the Surviving Sepsis Campaign (Dellinger et al, 2008). These recommendations were later superseded in the ‘Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012’ (Dellinger et al, 2012).

One of the criteria for severe sepsis on the SST is a lactate of >2 mmol/L, which NEAS paramedics have previously been unable to measure. The potential use of lactate in pre-hospital care has been reported elsewhere by the authors (McClelland et al, 2012) and provided some of the background for this study.

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed

Register
Or continue by

Signing in with your registered email address

Lactate
Point-of-care technology
Sepsis
Trauma