Paramedic Sepsis Identification and Potential Impact on Time to Antibiotic Treatment: A Retrospective Chart Review.

Abstract

Introduction: Timely administration of antibiotics improves sepsis outcomes. Our objectives were to determine the accuracy of paramedic sepsis recognition and to describe how potential paramedic antibiotic initiation could affect time to antibiotics. Methods: ED and EMS patients with suspected sepsis were retrospectively examined. Sensitivity and positive predictive value of paramedic recognition were calculated. The timeframes of care points were described and simulated to identify potential time savings associated with paramedic initiation of antibiotics. Results: The sensitivity of paramedic diagnosis compared to ED diagnosis was 21.10% [95% CI: 14.10%-29.80%]. The mean time between triage to antibiotic treatment was 3 hr 1 min. If paramedics initiated and had 73% sensitivity, time to antibiotics could improve to 1 hr 13 min [CI 95%: 0 hr 44 min - 1 hr 42min], and 76% of patients would receive antibiotics within one hour of FMC. Conclusion: Paramedics’ recognition in this sample was relatively low compared to previous literature. Our simulation suggests paramedic provision of antibiotics could improve time to treatment.