A comparative evaluation of 999 call-to-needle time of patients presenting with red flag sepsis treated with antibiotics by paramedics and emergency department staff

Abstract

Background National Institute for Health and Care Excellence guidelines on the recognition, diagnosis and early management of sepsis suggest that in all cases of high risk (or ‘red flag’) sepsis a broad spectrum antibiotic is given without delay and within one hour. For patients identified pre-hospital, GP’s and ambulance services are advised to have mechanisms in place that will allow them to give antibiotics but only where the transfer time is greater than one hour. Whilst one hour is considered the gold standard timeframe in which to receive antibiotics, the 999 call dispatch process is often overlooked and there are no studies to date that examine the 999 call-to-needle time for sepsis patients. The aim of this evaluation was to explore the difference between call-to-needle times of patients who present with ‘red flag’ sepsis receiving antibiotic therapy by a paramedic pre hospital versus Emergency Department (ED) staff. Method Data collected from a feasibility evaluation was used to determine the call-to-needle time of a broad spectrum antibiotic given by a trained paramedic prior to arrival at ED. A random sample of patients arriving in ED by ambulance with high risk (or ‘red flag’) sepsis during the same 6 month period was identified with the call-to-needle time collected retrospectively. A Mann-Whitney U test was performed using SPSS version 22 to determine if there was any significant difference. Results Of the patients that were treated (n=140) the median call-to-needle time of patients treated by paramedics was 45:30 min (n=60), compared to a median call-to-needle time by ED staff of 113:30 min (n=80) (p<0.001). Conclusion Considering the call dispatch challenges that all ambulance services experience, patients with ‘red flag’ sepsis can be treated with an antibiotic within an hour of the 999 call and on average one hour earlier than patients who are treated by ED staff. https://emj.bmj.com/content/34/10/e8.2 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/emermed-2017-207114.23