• Evaluation of pre-hospital point-of-care testing for lactate in sepsis and trauma patients

      Younger, Paul; McClelland, Graham (2014-10)
      Abstract published with permission. Objective: Lactate is a significant marker of critical illness and mortality in sepsis and trauma patients. The purpose of this study is to evaluate point-of-care lactate testing by paramedics in a UK ambulance service. Methods: Selected enhanced care paramedics were trained to use the lactate meter in patients with suspected sepsis and patients who trigger the major trauma bypass protocol. Feedback was collected on the practicalities of using the meter and the potential impact on the diagnosis of sepsis. Results: Data were collected on 114 patients, 96% had suspected sepsis (n=109) and 4% (n=5) were patients who had sustained trauma. The participants found that the ability to take lactate readings was useful and increased their confidence in their clinical decision making. Conclusions: Point-of-care lactate measurement is feasible in pre-hospital care and appears to support paramedics in their decision making.
    • Lactate measurement in pre-hospital care: a review of the literature

      McClelland, Graham; Younger, Paul; Byers, Sonia (2012-06)
      Abstract published with permission. Background: Lactate has been identified as a useful marker of shock. Lactate can be measured in the pre-hospital environment rapidly and accurately. Method: A comprehensive literature search was conducted using a targeted search strategy. Additional literature was located through reference list searching and prior awareness by the authors. This identified a number of papers which were appraised for relevance. This appraisal identified 29 papers which were included in the review. Conclusion: Lactate has been shown to be measurable in the pre-hospital environment and to be prognostic of mortality. Lactate measurement needs to be linked to specific treatment algorithms with improved outcomes for patients in order to justify inclusion in pre-hospital practice.
    • Moving sepsis care to the front line: knowledge and views of pre-hospital clinicians

      Roebuck, Elizabeth (2015-09)
      Abstract published with permission. Background: Previous in-hospital studies have highlighted the opportunity pre-hospital clinicians have to recognise sepsis at an early stage. Left untreated, mortality in septic shock increases rapidly. Sepsis screening tools have been developed to assist recognition; however, current knowledge of sepsis, effectiveness of previous training and attitudes towards implementation of a screening tool is unknown. Methods: A survey was emailed to 529 paramedics and 131 advanced technicians in the North of England to determine their current knowledge of sepsis, views around previous training and the use of a screening tool. Case studies were included to investigate current management of patients with history of infection. Results: 144 clinicians completed the survey, gaining a 21.8% response rate. 54% (95% CI 46%, 62%) of clinicians felt like they had good knowledge, leaving 46% of clinicians feeling a lack of knowledge. 94% (95% CI 89%, 97%) thought emergency departments should treat sepsis immediately or within the first hour. Case studies highlighted variability in the management pathways chosen and 98% (95% CI 94%, 99%) of clinicians required further training. 97% (95% CI 92%, 99%) agreed a screening tool would assist in the identification of septic patients and 98% (95% CI 95%, 99%) would use the tool. Conclusions: Severity level and importance of quick recognition and management are acknowledged among clinicians. Although response rate is a limitation of this study, knowledge levels differentiate greatly among the cohort and nearly all state they require further education. Clinicians agreed a screening tool would help identify septic patients and would use it alongside clinical acumen.
    • A pilot study exploring the accuracy of pre-hospital sepsis recognition in the North East Ambulance Service

      McClelland, Graham; Jones, Jacqui (2015-09)
      Abstract published with permission. Background: Over the past decade there has been a focus on improving pre-hospital recognition and treatment of patients with sepsis. This pilot study investigates pre-hospital sepsis recognition, including the use of a Sepsis Screening Tool (SST), treatment and whether timely identification influenced the time to treatment and outcome at the receiving unit. Methods: A cross-sectional sample of patients with a documented suspicion of sepsis by North East Ambulance Service NHS Foundation Trust (NEAS) was combined and cross referenced with patients coded for sepsis at The James Cook University Hospital (JCUH) to generate a sample of sepsis patients seen within January 2014. NEAS sepsis recognition was compared with SST identification by retrospectively examining patients’ medical records. Sensitivity and specificity for NEAS diagnosis were calculated by comparing NEAS identification with JCUH diagnosis using the hospital SST. Results: The sample included 49 patients from January 2014. NEAS correctly identified 18/42 patients with sepsis (43% sensitivity, 14% specificity). NEAS correctly identified 8/27 patients with severe sepsis (30% sensitivity, 77% specificity). Conclusions: It is evident that NEAS clinicians diagnose sepsis without consistently using the SST. Use of the SST would improve the ability of NEAS clinicians to identify patients with sepsis.
    • Pre-hospital lactate monitoring for adults with sepsis

      Charlton, Karl (2014-09)
      Abstract published with permission. Background: Sepsis is a life-threatening condition that claims 37 000 lives in the UK. The sepsis six care bundle was developed by the surviving sepsis campaign in 2002 to address this high mortality rate. Part of this care bundle involves measuring blood lactate which is prognostic of mortality. Lactate can be measured by paramedics in the pre-hospital setting using hand held monitors similar to blood glucose machines, with accuracy that is comparable to laboratory measured lactate. Method: A focused electronic literature search was carried out on a number of different databases as well as a hand search of specific relevant journals. Data was also obtained from reference harvesting, although the limitations of this was appreciated. Experts in the field were also contacted with relevant data obtained. An ongoing pre-hospital trial monitoring lactate was also identified and these researchers were contacted with relevant data obtained. Conclusions: Pre-hospital lactate monitoring would promote better recognition of sepsis in adults and improve the quality of care. It could be used to initiate a specific treatment regime such as intravenous antibiotics. This would reduce the numbers of patients admitted to intensive care, helping to reduce mortality and costs for the NHS.
    • Report from the first pre-hospital sepsis conference

      McClelland, Graham; Younger, Paul (2014-07)
    • A study into pre-alerts to North East hospitals for sepsis

      McClelland, Graham; Younger, Paul (2013-07)
      Abstract published with permission. A study of sepsis patients pre-alerted into hospitals was conducted in the North East of England from October 2011 to March 2013. This study was conducted to assess the effectiveness of the introduction of a sepsis education programme, which included a sepsis screening tool, and to try and establish the number of sepsis cases encountered by paramedics in the region. The results of this study show that the number of cases pre-alerted into the hospitals increased with the introduction of the screening tool, and gave some indications as to the number of sepsis patients encountered in pre-hospital care. We interpret the increase in pre-alerts as an increased awareness of sepsis, but see little impact on the treatment delivered by paramedics. We draw some conclusions on the number of suspected cases of sepsis seen in the pre-hospital environment but without linking to hospital data are unable to give definitive figures.