Prehospital Sepsis Recognition and Antibiotic Administration: A Retrospective Analysis

Although earlier antibiotics are known to be beneficial in sepsis, very few emergency medical services (EMS) agencies have protocols for prehospital antibiotics for sepsis. Therefore, we sought to assess how well a large EMS agency that uses prehospital antibiotics for sepsis adheres to its sepsis protocol (when initiated), and to determine how soon antibiotics are typically given.

We conducted a retrospective chart review of patients identified as "sepsis alerts" by EMS clinicians from a single EMS system in Florida, USA. The prehospital sepsis protocol dictated that EMS clinicians initiate a "sepsis alert" if the patient had a suspected infection and at least 2 of the following 3 criteria based on the sequential (sepsis-related) organ failure assessment (qSOFA) score: altered mental status, respiratory rate > 22 breaths per minute or end-tidal CO2 < 25 mmHg, or systolic blood pressure < 100 mmHg. Per protocol, patients meeting sepsis criteria were supposed to receive intravenous ceftriaxone and intramuscular gentamicin. We reviewed the charts of sepsis alert patients to determine demographic information, clinical characteristics, sepsis protocol compliance, and when patients received antibiotics.

Between June 1, 2023, and June 30, 2024, there were 1308 patients for whom a prehospital sepsis alert was initiated. Median age was 80.0 years (IQR: 72-87.5), and 48.5% had hypotension (systolic blood pressure < 100 mmHg). Of the 1308 sepsis alert patients, review of documentation confirmed that 1301 (99.5%) had a suspected infection with at least 2 sepsis alert criteria. In total, 1264 (96.6%) received at least 1 antibiotic (either ceftriaxone or gentamicin) prior to hospital arrival. The median time from 9-1-1 call to first antibiotic administration was 26 min (IQR: 21-31 min). The first antibiotic was given a median of 11 min (IQR: 7-16 min) prior to hospital arrival.

For patients in whom a sepsis alert was initiated, EMS clinicians adhered to the sepsis protocol and administered antibiotics prior to hospital arrival in 97% of cases. Patients received their first antibiotic a median of approximately 26 min after 9-1-1 call and 11 min prior to hospital arrival.