This article is based on the class "Improving EMS Sepsis Care: A Tale of Two Agencies", found on Prodigy EMS.
Sepsis is a life-threatening condition caused by the body's extreme response to an infection, leading to tissue damage, organ failure, and death. In the U.S., sepsis affects over 1.5 million people annually, with high mortality rates, particularly in cases of septic shock. As the leading cause of hospital deaths and the most expensive condition to treat, early intervention is crucial to improving outcomes and reducing healthcare costs.
Understanding Sepsis and Its Severity
Sepsis progression can be categorized into sepsis, severe sepsis, and septic shock:
- Sepsis: Infection plus systemic inflammatory response syndrome (SIRS), indicated by fever, tachycardia, high respiratory rate, or elevated white blood cell count.
- Severe Sepsis: Sepsis with organ dysfunction, hypotension, or altered mental status.
- Septic Shock: Persistent hypotension despite fluid resuscitation, requiring vasopressors to maintain blood pressure.
The updated sepsis definitions (Sepsis-3) use the qSOFA criteria (tachypnea, altered mental status, hypotension) to identify sepsis, emphasizing the importance of early detection and intervention.
The Role of EMS in Sepsis Management
Despite the critical nature of sepsis, pre-hospital care guidelines have historically overlooked the role of EMS clinicians in early sepsis management. The Surviving Sepsis Campaign, which provides comprehensive recommendations for sepsis care, fails to address the pre-hospital environment. This gap underscores the need for EMS protocols to incorporate early recognition and intervention for sepsis.
Controversies and Evidence in Fluid Resuscitation
Fluid resuscitation in sepsis patients is essential but controversial. Some studies, like the FEAST trial, suggest fluid restriction might be safer, especially in non-septic patients. However, early fluid administration is crucial for septic patients to improve cardiac output and tissue perfusion. Delayed or inadequate fluid resuscitation can lead to worsened outcomes and increased mortality.
Case Studies: Successful EMS Interventions
Two EMS agencies have demonstrated the positive impact of early fluid resuscitation in sepsis care:
WellStar EMS
WellStar EMS focused on early identification and aggressive fluid management for sepsis patients. By implementing rapid infusers, they provided substantial fluid resuscitation in the field, significantly improving patient outcomes. In a review of 50 recent sepsis cases:
- 35 were identified as septic shock or severe sepsis.
- Average fluid administration was 1,600 mL per patient.
- 48 out of 50 patients survived to hospital discharge.
Palm Beach Gardens Fire Rescue
Palm Beach Gardens Fire Rescue incorporated LifeFlow rapid infusers into their sepsis protocol, leading to a marked improvement in meeting fluid resuscitation benchmarks. Their protocol includes:
- Early identification of sepsis using SIRS criteria and end-tidal CO2 levels.
- Administering up to 2 liters of fluid in 500 mL increments.
- Use of push-dose epinephrine for persistent hypotension.
Their data showed a significant increase in average fluid administration and a corresponding improvement in patient outcomes, highlighting the importance of early and adequate fluid resuscitation.
Conclusion
Early fluid resuscitation is a critical component of sepsis management that can significantly improve patient outcomes. EMS clinicians play a vital role in the early recognition and treatment of sepsis, often determining the trajectory of the patient's condition before hospital admission. By adopting protocols that emphasize rapid and sufficient fluid administration, EMS agencies can make a substantial difference in the survival and recovery of sepsis patients. The success stories from WellStar EMS and Palm Beach Gardens Fire Rescue provide compelling evidence that early intervention saves lives and underscores the need for continued education and protocol development in pre-hospital sepsis care.