Opportunities for Emergency Medical Services Care of Sepsis

Overview

Journal Resuscitation

Specialty Emergency Medicine

Date 2009 Dec 17

PMID 20006419

Citations 33

Authors

Henry E Wang

Matthew D Weaver

Nathan I Shapiro

Donald M Yealy

Affiliations

Soon will be listed here.

Abstract

Objective: Emergency Medical Services (EMS) systems play key roles in the rapid identification and treatment of critical illness such as trauma, myocardial infarction and stroke. EMS often provides care for sepsis, a life-threatening sequelae of infection. In this study of Emergency Department patients admitted to the hospital with an infection, we characterized the patients receiving initial care by EMS.

Methods: We prospectively studied patients with suspected infection presenting to a 50,000 visit urban, academic ED from September 16, 2005-September 30, 2006. We included patients who had abnormal ED vital signs or required hospital admission. We identified patients that received EMS care. Between EMS and non-EMS patients, we compared patient age, sex, nursing home residency, vital signs, comorbidities, source of infection, organ dysfunction, sepsis severity and mortality. We analyzed the data using univariate odds ratios, the Wilcoxon rank-sum test and multivariate logistic regression.

Results: Of 4613 ED patients presenting with serious infections, 1576 (34.2%) received initial EMS care. The mortality rate among those transported by EMS was 126/1576 (8.0%) compared to 67/3037 (2.2%) in those who were not. Adjusted mortality was higher for EMS (OR 1.8, 95% CI: 1.3-2.6). Of patients who qualified for protocolized sepsis care in the ED, 99/162 (61.1%) were transported via EMS. EMS patients were more likely to present with severe sepsis (OR 3.9; 3.4-4.5) or septic shock (OR 3.6; 2.6-5.0). EMS patients had higher sepsis acuity (mortality in ED sepsis score 6 vs. 3, p<0.001).

Conclusions: EMS provides initial care for over one-third of ED infection patients, including the majority of patients with severe sepsis, septic shock, and those who ultimately die. EMS systems may offer important opportunities for advancing sepsis diagnosis and care.

Citing Articles

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Prior emergency medical services utilization is a risk factor for in-hospital death among patients with substance misuse: a retrospective cohort study.

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Diagnosis of sepsis in the emergency department: a real-world analysis from Lombardy, Italy.

Bosetti C, Santucci C, Signorini F, Cortellaro F, Villa G, Rossi C Intern Emerg Med. 2023; 19(2):313-320.

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Predicting sepsis using a combination of clinical information and molecular immune markers sampled in the ambulance.

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