Things Your System Should Deliver

What is reasonable to expect from a community’s EMS, and how should we measure it?

Now New Castle County paramedics have a sepsis protocol and are equipped with lactate meters. A venous lactate test is indicated for patients who have a suspected infection, high or low temperature, pulse above 90 or respiratory rate above 20. This covers a large number of patients, and the lactate reading helps identify which of them are likely to decompensate before they start to look sick. Based on this information, paramedics now request a sepsis alert, which triggers a hospital response similar to ones for STEMIs and strokes. For sepsis patients, early recognition, antibiotics and aggressive fluid resuscitation save lives. Preliminary data shows the estimated time saved from prehospital lactate is 98 minutes, and that prehospital sepsis alerts have cut the time to antibiotics in half.

Time to Raise the Bar

This is a case to make the following interventions available to every patient who calls 9-1-1 for EMS. It is based on evidence of how effective they are, their frequency and the difficulty in predicting over the telephone when they are needed.

• 12-lead ECGs incorporated into regional STEMI systems


• Nebulized bronchodilators

• Seizure medication

• Pain medication

• Chemical sedation


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2. Shiuh T, Sweeney T, Reed J. Effect of arrival mode to the emergency department on time to early goal-directed therapy of the septic patient. Prehosp Emerg Care, 2010 Jan; 14(Suppl1):5.


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