Can paramedics treat sepsis?

Abstract

Background: Sepsis is the most common time-critical medical emergency attended by UK paramedics but lacks the pre-hospital treatment options available for other common conditions. Sepsis treatment is simple, effective and quick to deliver and frontline paramedics may be able to significantly improve patient outcomes if empowered to recognise and treat sepsis. Methods: The Isle of Wight (IOW) Pre-hospital Piperacillin/Tazobactam (PrePip) project tested the concept that paramedics could accurately recognise and safely treat sepsis in the pre-hospital environment. By selecting two high-risk patient groups and developing new patient group directives and protocols for paramedic antibiotic delivery IOW sepsis treatment was radically altered to focus on early pre-hospital care. Results: The project showed that paramedics were highly effective in recognising sepsis in clearly defined patient groups with their diagnosis of sepsis being corroborated by in-patient consultants in 93% of cases. Paramedic-delivered interventions such as collection of blood cultures and administration of IV fluid and broad-spectrum IV antibiotics were shown to be both safe and timely. Conclusions: This project suggests that a new ‘call-to-needle’ paradigm of sepsis treatment may be possible, with UK paramedics providing key elements of the Sepsis Six before reaching the emergency department. This may have significant implications for restructuring sepsis services.