The Need for EMS to be on the Lookout for Pediatric SepsisPosted on by
Guest Author: Rommie L. Duckworth, LP
New England Center for Rescue & Emergency Medicine, LLC
Anya Coronel was born on April 18, 2009. A beautiful baby girl, Anya was born with spina bifida, a birth defect that, while corrected by surgery, would leave her prone to infections as well as a condition known as sepsis. Anya was healthy and vigorous when she returned home from her surgeries. She loved bath time and would only fall asleep to Ennio Morricone’s music from the movie “Cinema Paradiso.” However, after only a few days she developed a fever necessitating a return to the hospital. That fever would turn out to be the first sign of sepsis.
Globally, up to 6,000,000 children die every year from sepsis. In the United States alone there are more than 750,000 cases of adult and pediatric sepsis diagnosed each year. Of these, there are 42,000 cases of pediatric “severe sepsis,” more than 4,300 of whom will die from their illness.
So why is pediatric sepsis the most common deadly disease you’ve never heard of? Because even among professional healthcare providers, understanding and recognizing sepsis, especially in pediatric patients, is often lacking. Sepsis is often misunderstood as a vague, slowly progressing disease found only in elderly patients who have significant infections. The truth is that sepsis can strike patients of any age, including children, and can start as a minor wound or infection and quickly progress to a full-blown shutdown of the body’s vital organs.
While not traditionally thought of as a disease encountered by prehospital care providers, a study by one urban emergency department found that more than a third of all sepsis patients were received by EMS. Despite these patients being the sickest sepsis patients that the hospital encountered, only 2% of them passed away versus 8% of the sepsis patients who did not use EMS. Additional studies have demonstrated that when EMS transports sepsis patients, they can receive critical early treatments such as IV fluids and antibiotics earlier. EMS use of “Sepsis Alert” protocols also facilitate coordination with in-hospital teams for faster delivery of Early Goal Directed Therapy for sepsis.
Unfortunately, it has also been shown that such rapid recognition, management, and coordination of sepsis care is not found among all prehospital care providers. A 2013 study evaluated over 200 EMS providers, 83% of whom were paramedics and 73% of whom were in EMS for over 10 years. They were given four scenarios in which to identify septic shock. Only 10% of them correctly assessed all four scenarios.
While EMS systems in Colorado, North Carolina, Connecticut and elsewhere have robust education and sepsis alert programs, many other systems still have a long way to go. As part of an education program on how to rapidly recognize severe sepsis and septic shock, EMS providers of all levels are taught to check the ABC’s of SEPSIS:
- Acquired Infection
- Does the patient have a history of infection or of medical issues that will make them prone to infection?
- Blood Vessel Problems
- Check the patient’s circulatory status for early indicators of shock.
- Criteria for Sepsis Alert
- A variety of different prehospital sepsis alert criteria exist. EMS providers are taught to follow their local criteria.
While more in-depth programs and detailed guidelines exist, it is my hope that simple, straightforward tools like these will make it easy for both in-hospital and prehospital care providers to remember what to look for when faced with a potential sepsis patient and to pass this information on to their peers.
Sepsis is a silent killer. It could begin as pneumonia, peritonitis, a urinary tract infection, or a simple cut or wound. By the time it becomes apparent that something is terribly wrong, it may already be too late. It only takes one person to say something. One person to make a difference in early recognition and treatment.
For little Anya, after more than three weeks of intensive efforts in the ICU, she succumbed to her illness. Her story, like many others, is shared by Sepsis Alliance to educate and raise awareness among the public and healthcare providers through their “Faces of Sepsis” campaign (http://www.sepsis.org/faces/). Such stories and peer education are critical to help raise understanding and awareness of sepsis and to improve the recognition and management of victims of sepsis. It is the responsibility of every layperson, family member, physician, nurse, and EMS provider to be aware of the signs and symptoms and to be ready to ask out loud, “Could this be sepsis?” Because unrecognized sepsis kills. Be heard. Spread the word.