Format

Send to

Choose Destination
See comment in PubMed Commons below
Am J Emerg Med. 2012 Jan;30(1):51-6. doi: 10.1016/j.ajem.2010.09.015. Epub 2010 Oct 27.

The impact of emergency medical services on the ED care of severe sepsis.

Author information

1
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28203, USA.

Abstract

OBJECTIVE:

The identification and treatment of critical illness is often initiated by emergency medical services (EMS) providers. We hypothesized that emergency department (ED) patients with severe sepsis who received EMS care had more rapid recognition and treatment compared to non-EMS patients.

METHODS:

This was a prospective observational study of ED patients with severe sepsis treated with early goal-directed therapy (EGDT).We included adults with suspected infection, evidence of systemic inflammation, and either hypotension after a fluid bolus or elevated lactate. Prehospital and ED clinical variables and outcomes data were collected. The primary outcome was time to initiation of antibiotics in the ED.

RESULTS:

There were 311 patients, with 160 (51.4%) transported by EMS. Emergency medical services-transported patients had more organ failure (Sequential Organ Failure Assessment score, 7.0 vs 6.1; P = .02), shorter time to first antibiotics (111 vs 146 minutes, P = .001), and shorter time from triage to EGDT initiation (119 vs 160 minutes, P = .005) compared to non-EMS-transported patients. Among EMS patients, if the EMS provider indicated a written impression of sepsis, there was a shorter time to antibiotics (70 vs 122 minutes, P = .003) and a shorter time to EGDT initiation (69 vs 131 minutes, P = .001) compared to those without an impression of sepsis.

CONCLUSIONS:

In this prospective cohort, EMS provided initial care for half of the patients with severe sepsis requiring EGDT. Patients presented by EMS had more organ failure and a shorter time to both antibiotic and EGDT initiation in the ED.

PMID:
21030181
PMCID:
PMC3032016
DOI:
10.1016/j.ajem.2010.09.015
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Support Center