Open Access Highly Accessed Review

Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care

Johan Herlitz13*, Angela Bång1, Birgitta Wireklint-Sundström1, Christer Axelsson1, Anders Bremer1, Magnus Hagiwara1, Anders Jonsson1, Lars Lundberg1, Björn-Ove Suserud1 and Lars Ljungström2

Author Affiliations

1 School of Health Sciences, Research Centre PreHospen, University of Borås, The Prehospital Research Centre of Western Sweden, SE 501 90, Borås, Sweden

2 Department of Infectious Diseases, Skövde Central Hospital, Skövde, Sweden

3 Sahlgrenska University Hospital, SE 413 45, Göteborg, Sweden

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012, 20:42  doi:10.1186/1757-7241-20-42

Published: 27 June 2012

Abstract

Background

Sepsis is a life-threatening condition where the risk of death has been reported to be even higher than that associated with the major complications of atherosclerosis, i.e. myocardial infarction and stroke. In all three conditions, early treatment could limit organ dysfunction and thereby improve the prognosis.

Aim

To describe what has been published in the literature a/ with regard to the association between delay until start of treatment and outcome in sepsis with the emphasis on the pre-hospital phase and b/ to present published data and the opportunity to improve various links in the pre-hospital chain of care in sepsis.

Methods

A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases.

Results

In overall terms, we found a small number of articles (n = 12 of 1,162 unique hits) which addressed the prehospital phase. For each hour of delay until the start of antibiotics, the prognosis appeared to become worse. However, there was no evidence that prehospital treatment improved the prognosis.

Studies indicated that about half of the patients with severe sepsis used the emergency medical service (EMS) for transport to hospital. Patients who used the EMS experienced a shorter delay to treatment with antibiotics and the start of early goal-directed therapy (EGDT). Among EMS-transported patients, those in whom the EMS staff already suspected sepsis at the scene had a shorter delay to treatment with antibiotics and the start of EGDT.

There are insufficient data on other links in the prehospital chain of care, i.e. patients, bystanders and dispatchers.

Conclusion

Severe sepsis is a life-threatening condition. Previous studies suggest that, with every hour of delay until the start of antibiotics, the prognosis deteriorates. About half of the patients use the EMS. We need to know more about the present situation with regard to the different links in the prehospital chain of care in sepsis.

Keywords:
Sepsis; Dispatch centre; Emergency medical service