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Title: Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care.
Authors: Herlitz, Johan
Bång, Angela
Wireklint-Sundström, Birgitta
Axelsson, Christer
Bremer, Anders
Hagiwara, Magnus
Jonsson, Anders
Lundberg, Lars
Suserud, Björn-Ove
Ljungström, Lars
Department: University of Borås. School of Health Sciences
Issue Date: 2012
Journal Title: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
ISSN: 1757-7241
Volume: 20
Issue: 42
Publisher: BioMed Central Ltd.
Media type: text
Publication type: article, peer reviewed scientific
Keywords: prehospital care
Dispatch centre
Emergency medical service
Subject Category: Subject categories::Social Sciences Interdisciplinary::Nursing
Research Group: Prehospital akutsjukvård
Area of Research: Prehospital akutsjukvård
Strategic Research Area: Integrated nursing science
Abstract: Background Sepsis is a life-threatening condition where the risk of death has been reported to be even higher than that associated with the major complications of atherosclerosis, i.e. myocardial infarction and stroke. In all three conditions, early treatment could limit organ dysfunction and thereby improve the prognosis. Aim To describe what has been published in the literature a/ with regard to the association between delay until start of treatment and outcome in sepsis with the emphasis on the pre-hospital phase and b/ to present published data and the opportunity to improve various links in the pre-hospital chain of care in sepsis. Methods A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases. Results In overall terms, we found a small number of articles (n=12 of 1,162 unique hits) which addressed the prehospital phase. For each hour of delay until the start of antibiotics, the prognosis appeared to become worse. However, there was no evidence that prehospital treatment improved the prognosis. Studies indicated that about half of the patients with severe sepsis used the emergency medical service (EMS) for transport to hospital. Patients who used the EMS experienced a shorter delay to treatment with antibiotics and the start of early goal-directed therapy (EGDT). Among EMS-transported patients, those in whom the EMS staff already suspected sepsis at the scene had a shorter delay to treatment with antibiotics and the start of EGDT. There are insufficient data on other links in the prehospital chain of care, i.e. patients, bystanders and dispatchers. Conclusion Severe sepsis is a life-threatening condition. Previous studies suggest that, with every hour of delay until the start of antibiotics, the prognosis deteriorates. About half of the patients use the EMS. We need to know more about the present situation with regard to the different links in the prehospital chain of care in sepsis.
DOI: 10.1186/1757-7241-20-42
Sustainable development: sustainable development
Appears in Collections:Artiklar och rapporter / Articles and reports (VHB)

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