Abstract
Delayed antibiotic treatment for patients in severe sepsis and septic shock decreases the probability of survival. In this survey, medical directors of different emergency medical services (EMS) in Germany were asked if they are prepared for pre-hospital sepsis therapy with antibiotics or special algorithms to evaluate the individual preparations of the different rescue areas for the treatment of patients with this infectious disease. The objective of the survey was to obtain a general picture of the current status of the EMS with respect to rapid antibiotic treatment for sepsis. A total of 166 medical directors were invited to complete a short survey on behalf of the different rescue service districts in Germany via an electronic cover letter. Of the rescue districts, 25.6 % (n = 20) stated that they keep antibiotics on EMS vehicles. In addition, 2.6 % carry blood cultures on the vehicles. The most common antibiotic is ceftriaxone (third generation cephalosporin). In total, 8 (10.3 %) rescue districts use an algorithm for patients with sepsis, severe sepsis or septic shock. Although the German EMS is an emergency physician-based rescue system, special opportunities in the form of antibiotics on emergency physician vehicles are missing. Simultaneously, only 10.3 % of the rescue districts use a special algorithm for sepsis therapy. Sepsis, severe sepsis and septic shock do not appear to be prioritized as highly as these deadly diseases should be in the pre-hospital setting.
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References
Engel C, Brunkhorst FM, Bone H-G et al (2007) Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intensive Care Med 33:606–618. doi:10.1007/s00134-006-0517-7
Angus DC, Linde-Zwirble WT, Lidicker J et al (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310. doi:10.1097/00003246-200107000-00002
Padkin A, Goldfrad C, Brady AR et al (2003) Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland. Crit Care Med 31:2332–2338. doi:10.1097/01.CCM.0000085141.75513.2B
Perner A (2013) Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis 1A02, 2C04. J Intensive Care Soc 14:82–83. doi:10.1056/NEJMoa1204242
Holst LB, Haase N, Wetterslev J et al (2014) Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med 371:1381–1391. doi:10.1056/NEJMoa1406617
Gottlieb M, Bailitz J (2015) Comparison of early goal-directed therapy with usual care for severe sepsis and septic shock. Ann Emerg Med. doi:10.1016/j.annemergmed.2015.05.025
ProCess Investigators, Yealy DM, Kellum JA et al (2014) A randomized trial of protocol-based care for early septic shock. N Engl J Med 370:1683–1693. doi:10.1056/NEJMoa1401602
Oppert M (2012) Effect of empirical treatment with moxifloxacin and meropenem vs meropenem on sepsis-related organ dysfunction in patients. JAMA J Am Med Assoc. doi:10.1001/jama.2012.5833
Herlitz J, Bång A, Wireklint-Sundström B et al (2012) Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care. Scand J Trauma Resusc Emerg Med 20:42. doi:10.1186/1757-7241-20-42
Bayer O, Schwarzkopf D, Stumme C et al (2015) An early warning scoring system to identify septic patients in the prehospital setting: the PRESEP Score. Acad Emerg Med 22:868–871. doi:10.1111/acem.12707
Báez AA, Hanudel P, Perez MT et al (2013) Prehospital sepsis project (PSP): knowledge and attitudes of United States advanced out-of-hospital care providers. Prehosp Disaster Med 28:104–106. doi:10.1017/S1049023X12001744
Polito CC, Isakov A, Yancey AH et al (2015) Prehospital recognition of severe sepsis: development and validation of a novel emergency medical services screening tool. Am J Emerg Med. doi:10.1016/j.ajem.2015.04.024
Guerra WF, Mayfield TR, Meyers MS et al (2013) Early detection and treatment of patients with severe sepsis by prehospital personnel. J Emerg Med 44:1116–1125. doi:10.1016/j.jemermed.2012.11.003
Donnino MW, Fisher J (2006) Determining disease severity in severe sepsis and septic shock. Intern Emerg Med 1:219–220
Çildir E, Bulut M, Akalin H et al (2013) Evaluation of the modified MEDS, MEWS score and Charlson comorbidity index in patients with community acquired sepsis in the emergency department. Intern Emerg Med 8:255–260. doi:10.1007/s11739-012-0890-x
Jon Femling PhDMD, Steven Weiss MD, Eric Hauswald BA, David Tarby MD (2014) EMS patients and walk-in patients presenting with severe sepsis: differences in management and outcome. South Med J 107:751–756. doi:10.14423/SMJ.0000000000000206
Studnek JR, Artho MR, Garner CL, Jones AE (2012) The impact of emergency medical services on the ED care of severe sepsis. Am J Emerg Med 30:51–56. doi:10.1016/j.ajem.2010.09.015
Gaieski DF, Mikkelsen ME, Band RA et al (2010) Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Crit Care Med 38:1045–1053. doi:10.1097/CCM.0b013e3181cc4824
Kumar A, Roberts D, Wood KE et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34:1589–1596. doi:10.1097/01.CCM.0000217961.75225.E9
Peters O, Runggaldier K, Schlechtriemen T (2007) Algorithms in emergency medicine. Notfall+Rettungsmedizin 10:229–236. doi:10.1007/s10049-006-0886-z
German Association of Emergency Technician (DBRD) (2015) Algorithms for implementation of the pyramid process an part of the NotSanG-Legislation
The Federal Institute for Research on Building UA and SD (BBSR) Siedlungsstrukturelle Kreistypen. http://www.bbsr.bund.de/BBSR/DE/Raumbeobachtung/Raumabgrenzungen/Kreistypen4/kreistypen.html;jsessionid=FBB8E18A06F8580D635F20D0DA65F77E.live1042?nn=443222
Theobald A, Dreyer M, Starsetzki T (2003) Online Marktforschung. Wiesbaden. doi:10.1007/978-3-663-10948-8
Joos S, Roos M, Ledig T et al (2011) Perspectives and experiences of vocational trainers in general practice. Z Evid Fortbild Qual Gesundhwes 105:97–104
Neugebauer E, Sauerland S, Keck V et al (2003) Leitlinien Akutschmerztherapie und ihre Umsetzung in der Chirurgie—Eine deutschlandweite Kliniksumfrage. Der Chir 74:235–238
Meuser T, Grond S, Lynch J et al (1997) Stand der Analgesie und Anästhesie in der Geburtshilfe—Eine Umfrage aus Nordrhein. Anaesthesist 46:532–535
Geyer BC, H.Kaji A, Katz ED, et al. (2015) A national evaluation of the scholary acitivity requirement in residency programs. Acad Emerg Med 22:1337–44
Doty CI, Roppolo LP, Asher S et al (2015) How do emergency medicine programs structure their clinical competency committees. Acad Emerg Med 22:1351–1354
Vogel F et al (2010) Empfehlungen zur kalkulierten parenteralen Initialtherapie bakterieller Erkrankungen bei Erwachsenen. Chemother J 19:179–255
Wrede CE, Reinhart K (2014) Sepsis in emergency medicine. Notfall + Rettungsmedizin 17:707–717. doi:10.1007/s10049-014-1962-4
Dellinger RP, Levy MM, Rhodes A et al (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228. doi:10.1007/s00134-012-2769-8
Harrison DA, Sadique MZ et al (2015) Trial of early, goal-directed resuscitation for septic shock. 1–11. doi:10.1056/NEJMoa1500896
Bailey M, Bellomo R, Peter A et al (2014) Goal-directed resuscitation for patients with early septic shock. N Engl J Med. doi:10.1056/NEJMoa1404380
Bossi IE, Rusconi AM, Lampard G, Szava-Kovats M (2015) Is there a benefit for a care protocol in the treatment of septic shock? Intern Emerg Med 10:83–85. doi:10.1007/s11739-014-1151-y
Investigators TP (2014) A randomized trial of protocol-based care for early septic shock. Process trial. N Engl J Med 370:1–11. doi:10.1056/NEJMoa1401602
Kaukonen, Kirsi-Maija; Bailey, Michael; Pilcher, David; Cooper, D Jamie; Bellomo R (2015) Systemic Inflammatory Response Syndrome Criteria in Defining Severe Sepsis. N Engl J Med 372:1629–1638. doi:10.1056/NEJMoa1415236
Marik PE (2015) The demise of early goal-directed therapy for severe sepsis and septic shock. Acta Anaesthesiol Scand. doi:10.1111/aas.12479
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Casu, S., Häske, D. Severe sepsis and septic shock in pre-hospital emergency medicine: survey results of medical directors of emergency medical services concerning antibiotics, blood cultures and algorithms. Intern Emerg Med 11, 571–576 (2016). https://doi.org/10.1007/s11739-015-1371-9
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DOI: https://doi.org/10.1007/s11739-015-1371-9