Hi, Josie, Even though there's a pretty clear association between time-to-antibiotics and outcome in severe sepsis, what little there is evidence on prehospital administration of antibiotics for severe infection is mixed at best, with some studies showing patients actually having worse outcomes in certain situations. That said, a lot of this research was done with general practitioners and generalized to other out-of-hospital providers like paramedics. If you'd like to take a look at a review article that covers the matter there's one here: http://www.sjtrem.com/content/20/1/42#B26Particularly notable for your question is a retrospective observational study from the UK conducted during the 2000's that found paramedics had trouble with protocol compliance when it comes to administering prehospital antibiotics. ( http://ro.ecu.edu.au/cgi/viewcontent.cgi?article=1136&context=jephc)
If you're going to argue for starting antibiotic treatment of sepsis in the prehospital setting, I think the first thing you need to do is examine how good your EMS system is at detecting sepsis: if you can't pick it out you can't treat it. Traditionally paramedics haven't been very good at identifying sepsis patients, and on this side of the pond at least there's some pretty good research to show that paramedics have significant knowledge gaps about sepsis vis-a-vis other time-dependant life-threatening conditions like stroke and AMI. Even if your system is currently requiring bachelor's degrees at the entry level I'm guessing you've got a lot of personnel who pre-date that policy, and those folks might not have ever received systematic training on sepsis. Secondly, what criteria are you using for recognizing sepsis? Not every septic patient has a big, red, inflamed sign blinking “I'm Septic” over his or her head, and right now to my knowledge there's only one validated tool for detecting prehospital sepsis in the literature ( http://www.jem-journal.com/article/PIIS0736467912014412/abstract<http://www.jem-journal.com/article/PIIS0736467912014412/abstract?rss=yes>). That tool requires point-of-care lactate testing. If you're not using point-of-care lactate testing, or if your system has a mixed bag when it comes to paramedic knowledge about sepsis, these items are probably the low-hanging fruit for improving sepsis care in your system, and if you haven't got these things covered talking about prehospital antibiotics is premature. If your system does have these two things squared away then you could probably argue for prehospital administration of wide-spectrum antibiotics. I don't have an article link handy, but if I recall evidence from the ER setting consistently shows improvement in patient outcomes when a systematic approach to sepsis is enforced. I think it's likely that the mixed results for pre-hospital antibiotics that exist in the literature are more a result of a disorganized approach in which sicker patients ended up getting antibiotics more often than anything intrinsic about prehospital antibiotics, and I think if an EMS system is armed with paramedics who are knowledgeable about sepsis and have good tools to detect it we might see an improvement in outcomes with an aggressive approach that includes prehospital antibiotics. Jason Merrill Primary Care Paramedic *Do you know the warning signs of a heart attack<http://www.heartandstroke.nf.ca/site/c.inKLKTOwHoE/b.3654523/k.C091/Heart_Disease__Warning_signs.htm#warningsignals>, stroke<http://www.heartandstroke.nf.ca/site/c.inKLKTOwHoE/b.3654543/k.760A/Stroke__Warning_Signs.htm>, or serious allergic reaction<http://www.anaphylaxis.ca/en/anaphylaxis101/the_basics.html> ?* * * *This e-mail is intended as a private communication with its intended recipient, and may contain confidential information which is protected by law. If you believe that you have received this e-mail in error, please delete it and notify the sender by replying to this e-mail address, or calling 1-877-661-4715 in North America or **+883-5100-01393793 elsewhere**. Nothing in this e-mail is intended as medical or paramedical advice.*
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