Daniel Lane
Doctorate
Doctorate Title: Prehospital recognition and management of sepsis.
Doctorate Description: Introduction: Sepsis is a syndrome characterized by organ dysfunction due to a dysregulated host response to infection and remains a leading cause of morbidity and mortality across the world. Early identification and prompt treatment are essential to improving outcomes of patients with sepsis, and in established healthcare systems Emergency Medical Services (EMS) paramedics are often the first healthcare contact for these patients. To promote earlier identification and timely delivery of effective treatment, a better understanding of the epidemiology of patients with sepsis who are encountered by EMS is required.
Objective: This thesis 1) describes characteristics of patients with infections and sepsis encountered by EMS in a large Canadian province, 2) validates existing approaches for the identification of infections and sepsis by paramedics, and 3) evaluates the impact of a current EMS treatment on process and patient outcomes.
Synthesis: The one-year incidence of sepsis among EMS-transported patients was 2.1%. For patients with sepsis, the in-hospital mortality rate was 28% - accounting for 12% of all deaths occurring in EMS-transported patients. Paramedics documented suspicion of sepsis in only 11% of patients with infections and 9% of patients with sepsis. To improve identification, operational characteristics (e.g. dispatch categories) and temperature measurement can identify patients with higher risk of infection. Then simple screening strategies can be applied to these patients to identify those at high-risk for sepsis diagnosis. Intravenous fluid treatment by paramedics for patients with sepsis was associated with reduced mortality in patients with low initial systolic blood pressure, but harm in patients with high initial systolic blood pressure.
Conclusion: EMS systems should implement simple screening strategies to promote earlier identification of patients with infections and sepsis, who are at high-risk for mortality and require urgent intervention.
Details:
Type: PhD
University: University of Toronto
Primary Supervisor: Dr Damon Scales
Category: Infection
Funding: None
Start Date: 2015
End Date: 2018
Status: Complete
/ Ongoing
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