Abstract

BackgroundIn order to dispatch ambulances with the correct level of urgency, the dispatch center has to balance the perceived urgency and traffic safety considerations with the available resources. As urgency is not clear in all clinical situations, some high urgency patients may end up with a suboptimal mode of transport.Patients with severe sepsis or septic shock suffer from highly time dependent conditions but they present with a wide range of symptoms, which might be difficult to identify in the dispatch system.The aim of the study is to investigate the modes of prehospital transport among acute admitted patients with sepsis, severe sepsis and septic shock.MethodsWe included all adult patients (≥15 years) presenting to an acute medical unit at Odense University Hospital with a first-time admission of community-acquired sepsis between September 2010-August 2011. Cases and prehospital ambulance transport were identified by structured manual chart review. In all cases it was registered, whether the ordinary ambulance was assisted by the mobile emergency care unit (MECU), manned by anesthesiologists.ResultsWe included 1,713 patients median age 72 years (IQR 57–81), 793 (46.3%) male, 621 (36.3%) had sepsis, 1,071 (62.5%) severe sepsis, and 21 (1.2%) septic shock.In the group of sepsis patients, 390 (62.8%) arrived without public prehospital transport, 197 (31.7%) were transported by ambulance, and 34 (5.5%) were assisted by MECU. In the group of severe sepsis patients, the same percentage 62.8% arrived without public pre-hospital transport, a lower percentage 28.2% were transported by ambulance, and a larger percentage 9.0% were transported by MECU. Among 21 patients with septic shock, 10 arrived without public pre-hospital transport (47.7%), 7 (33.3%) were transported by ambulance, and 4 (19.0%) by MECU.The 30-day mortality hazard ratio was associated with mode of transport, with the adjusted highest hazard ratio found in the group of MECU transported patients 1.76 (95%Cl 1.16–2.66).ConclusionsA substantial proportion of patients with severe sepsis and septic shock arrive to hospital without public prehospital transport or by unspecialized ambulances.

Highlights

  • In order to dispatch ambulances with the correct level of urgency, the dispatch center has to balance the perceived urgency and traffic safety considerations with the available resources

  • In the group of patients with sepsis, 390 (62.8%, 95%CI 58.9–66.6%) arrived without public prehospital transport, 197 (31.7%, 95%CI 28.1–35.5%) were transported by ambulance, and 34 (5.5%, 95%CI 3.8–7.7%) were assisted by mobile emergency care units (MECU)

  • In the severe sepsis patients group, the same percentage 62.8% (95%CI 59.9– 65.7%) arrived without public pre-hospital transport, a lower percentage 28.2% (95%CI 25.5–31.0%) were transported by ambulance, and a larger percentage 9.0% (95%CI 7.3–10.8%) were transported by MECU compared to the sepsis group

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Summary

Introduction

In order to dispatch ambulances with the correct level of urgency, the dispatch center has to balance the perceived urgency and traffic safety considerations with the available resources. Patients with severe sepsis or septic shock suffer from highly time dependent conditions but they present with a wide range of symptoms, which might be difficult to identify in the dispatch system. The aim of the study is to investigate the modes of prehospital transport among acute admitted patients with sepsis, severe sepsis and septic shock. Optimal dispatch of prehospital patient transport is a balance between expected urgency, considerations pertaining to traffic safety and available resources. The aim is that the correct mode of transportation is dispatched to all patients at all time [3]. Urgency is not clear in all clinical situations, and some high urgency patients end up with a suboptimal mode of transport [4]

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