Identifying Sepsis in the Prehospital Setting
Four Strategies EMS Teams Can Use to Improve Sepsis Detection
Introduction
With a third of in-hospital deaths caused by sepsis, the Centers for Disease Control and Prevention has declared sepsis a public health issue. EMS agencies play a key role in early detection, transporting almost half of all sepsis cases.
Even so, only 61% of EMS practitioners are aware of all sepsis indicators, and many report having to track down sepsis resources themselves. The four strategies below can help EMS teams improve sepsis care in the prehospital setting.
Recognizing the signs is the foundation of early detection. According to the Sepsis Alliance, EMS practitioners do not always recognize the many common presentations. Comparing EMS impressions with hospital ICD-10 codes in ESO data shows that sepsis is commonly recorded as respiratory distress, generalized weakness, or an altered level of consciousness.
EMS provider impression breakdown for hospital-diagnosed sepsis cases
Share of hospital-diagnosed sepsis patients by EMS primary impression.
To raise awareness of sepsis and the importance of fast treatment, the Sepsis Alliance developed the It’s About TIME campaign. It works as an identification tool for prehospital teams and as a public awareness aid.
Alongside tools like TIME, it is well established that elevated lactate levels are associated with severe sepsis. Point-of-care lactate testing is available in the prehospital environment, but EMS teams can also use end-tidal capnography, already present on most ALS units, and avoid the added cost of point-of-care tests.
End-tidal carbon dioxide levels fall as lactate levels rise, so a low EtCO2 value may predict mortality in patients suspected of sepsis, severe sepsis, or septic shock.
Warning the hospital that your patient may be septic is central to effective treatment. It gives the emergency department time to assemble the treatment team before handoff, and lets the hospital prioritize your patient over less serious cases.
Document the key information that helps the hospital understand the potential cause of sepsis, and share it with hospital personnel.
Advocating for a suspected sepsis patient means being loud with the emergency department. Be clear that you think your patient has sepsis in every exchange, en route and at handoff.
Use everything in your communications toolkit, whether that is radio, EHR system alerts, or face-to-face conversation, so the emergency department knows your patient status at every turn.
Conclusion
More work is needed to improve sepsis identification and treatment across the whole continuum of care. EMS teams can make a difference today by combining these identification tools with early notification systems.
References
- Sepsis Alliance. Sepsis First Response. 10 Aug 2018.
- Sepsis Alliance. Sepsis and EMS Survey. 2019.
- Hunter CL. Use End-tidal Carbon Dioxide to Diagnose Sepsis. The Journal of Emergency Medicine. 3 Mar 2014.
- Hunter CL, Silvestri S, Dean M, et al. End-tidal carbon dioxide is associated with lactate levels and mortality in emergency department patients with suspected sepsis. Am J Emerg Med. 2013;31(1):64–71.
- McGillicuddy DC, Tang A, Cataldo L, et al. Evaluation of end-tidal carbon dioxide role in predicting elevated SOFA scores and lactic acidosis. Intern Emerg Med. 2009;4(1):41–44.
