By Mike McEvoy
A study of King County (Seattle, Washington) EMS calls from 2000 to 2009 discovered that EMS providers see more patients with severe sepsis (3.3 percent of EMS calls) than acute myocardial infarctions (2.3 percent). This surprising finding, reported by researchers in the December 2012 issue of the American Journal of Respiratory and Critical Care Medicine, also found that more than 40 percent of all severe sepsis cases arrive at the hospital by EMS. There are multiple opportunities for improvement, most significant of which were extended scene times in patients with severe sepsis, averaging 35 minutes and only 37 percent arrived in the ED with an IV in place. Given the success of EMS with rapid identification and transport of MI and stroke patients, and the dismal outcomes for in-hospital treatment of severe sepsis who have a 20 to 30 percent mortality rate, it may be time to examine our EMS protocols for patients with suspected sepsis.
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;186:1264–1271.
MIKE McEVOY, PhD, NRP, RN, CCRN is the EMS Coordinator for Saratoga County, NY and the Fire Engineering EMS editor. He is a professor emeritus of critical care medicine at Albany Medical College in New York and continues to practice as a clinical nurse specialist in the Cardiac Surgical ICUs at Albany Medical Center. Mike is a paramedic for Clifton Park & Halfmoon Ambulance and the Chief Medical Officer for West Crescent Fire Department. He is a Board Member of the New York State Association of Fire Chiefs and a popular speaker at Fire, EMS, and medical conference worldwide.