Regarding prehospital antibiotics, I know it was tried in the UK for a while at one point, but I don't think their outcomes improved.
The research I'm aware of on the topic of prehospital antibiotics for sepsis is extremely weak, mostly poorly designed, and often generalized from non-EMS out-of-hospital settings. That said, I'm not aware of anything that shows a survival benefit for this intervention. A few pieces of research even show relatively poor outcomes for patients who get prehospital antibiotics, though those bits of research all had big, nasty confounding factors that probably invalidate their findings. I'm curious what's driving your decision to implement prehospital antibiotics. It seems to me that the low-hanging fruit in most systems is presently better sepsis recognition and better communication with the ER. Jason Merrill Primary Care Paramedic/EMT-A 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. --------------------------------------------------------------------- On Tue, 05 Aug 2014 10:05:30 -0700, [email protected] wrote: | Send Sepsisgroups mailing list submissions to | [email protected] | | To subscribe or unsubscribe via the World Wide Web, visit | http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org | | or, via email, send a message with subject or body 'help' to | [email protected] | | You can reach the person managing the list at | [email protected] | | When replying, please edit your Subject line so it is more specific | than "Re: Contents of Sepsisgroups digest..." | | | Today's Topics: | | 1. Sepsis Screening & Incidence in Inpatient Mental Health Areas | (Schnoor, Evelyn L.) | 2. Re: Antibiotic by EMS (Muhr, Lori) | 3. Pre-hospital Sepsis CPG (Denis Daly) | | | ---------------------------------------------------------------------- | | Message: 1 | Date: Fri, 1 Aug 2014 16:35:48 +0000 | From: "Schnoor, Evelyn L." <[email protected]> | To: "[email protected]" | <[email protected]> | Subject: [Sepsis Groups] Sepsis Screening & Incidence in Inpatient | Mental Health Areas | Message-ID: | <[email protected]> | Content-Type: text/plain; charset="us-ascii" | | Good day. We have updated our sepsis screening practices in our 3 hospitals locally to comply with our newly standardized corporate process for sepsis care. We have had an interesting question from one of our local clinical areas in adolescent behavioral health that we can't answer. So, I am turning to you for your advice at the recommendation of Stephen L. Davidow, MBA-HCM, APR, Lean Health Care Certified, Six Sigma Green Belt in Health Care | Manager, Quality Implementation Programs | Society of Critical Care Medicine. | | | | We have a behavioral health/chemical dependency program affiliated with one of our hospitals locally that offers inpatient mental health services and acute care detox. We know the adolescent population presents with cutting issues, needle marks, and other reasons that might create a potential sepsis situation. What percentage of adolescent behavioral patients across the U.S. actually present with or develop sepsis in an inpatient behavioral/mental health environment? We are trying to establish reasonable sepsis screening frequency guidelines with them. We decided to screen our acute care geriatric psych population once in every 8 hour shift because of their age, comorbidities, etc. It's the adolescent/children populations we are not sure about. Does anyone have suggestions or research about sepsis incidence, frequency of screening, etc. in the behavioral/mental health populations? It is easier to garner support for change when we have the science/research behind the re | quest. | | Thank you very much for your assistance. | | Evelyn Schnoor, MSN, RN, ACNS-BC | Process Improvement Coord. | | [cid:[email protected]] | | Methodist | Lutheran | Methodist West | Blank Children's | | Iowa Lutheran Hospital | 700 E. University Ave., Des Moines, IA 50316 | Office: 515-263-5507, FAX: 515-263-5415 | Email: [email protected]<mailto:[email protected]> | | | This message and accompanying documents are covered by the Electronic Communications Privacy Act, 18 U.S.C. sections 2510-2521, and contain information intended for the specified individual(s) only. This information is confidential. If you are not the intended recipient or an agent responsible for delivering it to the intended recipient, you are hereby notified that you have received this document in error and that any review, dissemination, copying, or the taking of any action based on the contents of this information is strictly prohibited. If you have received this communication in error, please notify us immediately by e-mail, and delete the original message. | -------------- next part -------------- | An HTML attachment was scrubbed... | URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140801/9782ae3a/attachment.htm> | -------------- next part -------------- | A non-text attachment was scrubbed... | Name: image001.jpg | Type: image/jpeg | Size: 2647 bytes | Desc: image001.jpg | URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140801/9782ae3a/attachment.jpg> | | ------------------------------ | | Message: 2 | Date: Fri, 1 Aug 2014 19:22:53 +0000 | From: "Muhr, Lori" <[email protected]> | To: "[email protected]" | <[email protected]> | Subject: Re: [Sepsis Groups] Antibiotic by EMS | Message-ID: | <ac1acc651979404686489f99b6d0220022dd7...@rdcexdb101.jpshealthnetwork.org> | | Content-Type: text/plain; charset="us-ascii" | | Really? | | Unless you have a significantly long transport time is this really necessary? EMS should focus on getting the IV started and fluids initiated and transport with as much info as possible. (Co-morbidities, medications, treatments, and advance directives) | | Unless you have a MD in the box with them, you are opening them up to potential complications with administering antibiotics in the field. | | The goal of the Sepsis program should be to get the patient to a facility that can treat them as quickly as possible, preferably a facility that understand and uses the Surviving Sepsis Guidelines. | | I live in Texas, and believe me I can tell you about long transport times, but our EMS is focused on getting 2 IV lines, fluids started and the patient transported. | | Lori J. Muhr MSN, MHSM/MHA, APRN, ACNS-BC, CCRN, CEN | Adult Clinical Nurse Specialist - Sepsis Program Director | Quality Services | 817-702-1717 | [email protected] | | -----Original Message----- | From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] | Sent: Friday, August 01, 2014 2:08 PM | To: [email protected] | Subject: Sepsisgroups Digest, Vol 119, Issue 6 | | Send Sepsisgroups mailing list submissions to | [email protected] | | To subscribe or unsubscribe via the World Wide Web, visit | http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org | | or, via email, send a message with subject or body 'help' to | [email protected] | | You can reach the person managing the list at | [email protected] | | When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." | | | Today's Topics: | | 1. Antibiotics initiated by EMS (Sue Beswick) | | | ---------------------------------------------------------------------- | | Message: 1 | Date: Thu, 31 Jul 2014 20:38:43 +0000 | From: Sue Beswick <[email protected]> | To: "'[email protected]'" | <[email protected]> | Subject: [Sepsis Groups] Antibiotics initiated by EMS | Message-ID: | <[email protected]> | Content-Type: text/plain; charset="us-ascii" | | We are working on a process to initiating sepsis tx including antibiotics in the with our county EMS and am looking at all of you for your expertise. | | | 1. Develop an algorithm for EMS with SIRS criteria and suspected infection. The only measure they won't have in the field is WBC. | | 2. If sepsis criteria met - EMS will obtain a LA (point of care) in patients meeting sepsis criteria - looking to obtain in the field to help in identification of severe sepsis (esp. those who may not look that sick) | | 3. We have met with lab and will get the first blood culture in the field. EMS to do training bi-annually to assure proper technique. Would only do this for patients who are stable enough to take the extra few minutes to initiate this process. | | 4. Initiate fluids - simplifying protocol for 2 L for patients under 80 kg and 3L for > 80 kg. | | 5. We have also met with pharmacy and have worked out a process to have Zosyn and Rocephin available and part of the protocol to initiate in the field. EMS feels pretty confident with suspicion of pneumonia and UTI and will focus primarily on those patients with Rocephin for pneumonia and Zosyn for UTI and other suspicious sources. Once arrives to ED, the physician can fine tune abx. EMS will hold abx for patients with PCN allergy or if unsure and let ED physician make decision. | | 6. On arrival to ED - blood culture will be sent to lab and second culture drawn. Will continue with usual sepsis care then. | | One of our concerns is the pneumonia measure for antibiotic and eventual sepsis measure for abx. We plan to use arrival time for our internal abx time given. | | * Not sure what this will do to pneumonia measures. Quality says as long as all appropriate antibiotics are given within 24 hours, the patient will not fall out of the measure. Concern is for abx ordered every 24 hours or renal patient - how to meet the measure. We are going to work on making this process work for us. We are also finding an issue with this at our MD360 offices where they can start antibiotics and how this in impacting measures. | | * We've just started looking at participating in the surviving sepsis data base and will probably enter time of abx as time of arrival?? Not sure yet how that will work. | | Anyone have any thoughts or ideas that we haven't thought of? | | Sue | | Sue Beswick APRN, MS, CCNS, CCRN | CNS Critical Care | Greenville Health System | 701 Grove Road l Greenville, SC 29605 | Office: 864-455-4884 | | -------------- next part -------------- | An HTML attachment was scrubbed... | URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140731/960d32ef/attachment.html> | | ------------------------------ | | Subject: Digest Footer | | _______________________________________________ | Sepsisgroups mailing list | [email protected] | http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org | | | ------------------------------ | | End of Sepsisgroups Digest, Vol 119, Issue 6 | ******************************************** | | | | | | This electronic transmission and any attached files are intended solely for the person or entity to which they are addressed and may contain information that is privileged, confidential or otherwise protected from disclosure under applicable law. Any review, retransmission, dissemination or other use, including taking any action concerning this information by anyone other than the named recipient, is strictly prohibited. If you are not the intended recipient or have received this communication in error, please immediately notify the sender by return email and delete the original message from your system. | | | | ------------------------------ | | Message: 3 | Date: Mon, 4 Aug 2014 11:40:28 +0100 | From: Denis Daly <[email protected]> | To: [email protected] | Subject: [Sepsis Groups] Pre-hospital Sepsis CPG | Message-ID: | <cafv9udexjlhz-4skc-ye81x3_bhju2+tlc0zdkangoseu7a...@mail.gmail.com> | Content-Type: text/plain; charset="iso-8859-1" | | Hi all, | I would appreciate any comments or feedback on this clinical practice | guideline currently being rolled out in Ireland. | Thanks | Denis | -------------- next part -------------- | An HTML attachment was scrubbed... | URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140804/445040d0/attachment.htm> | -------------- next part -------------- | A non-text attachment was scrubbed... | Name: Advanced Paramedic CPGs 2014 Sepsis.pdf | Type: application/pdf | Size: 80710 bytes | Desc: not available | URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140804/445040d0/attachment.pdf> | | ------------------------------ | | Subject: Digest Footer | | _______________________________________________ | Sepsisgroups mailing list | [email protected] | http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org | | | ------------------------------ | | End of Sepsisgroups Digest, Vol 120, Issue 1 | ******************************************** | _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
