Table 1 Current and optimized practices according to the “chain of survival for sepsis” concept and proposals to achieve its goals
Current practices | Optimized practices | Proposals |
|---|---|---|
Incomplete awareness and understanding | - Earlier sepsis recognition - Earlier prehospital EMS management (call and ambulance dispatch to the scene) | Educational and public service courses to raise awareness of sepsis among primary care, general practitioners, nurses, paramedics, prehospital EMS regulation call centers and prehospital emergency medical teams |
Scores (qSOFA, MRST, MEWS, SIRS, NEWS, PRESEP) insufficient to predict ICU admission | Sensitive and specific scoring tools to assess sepsis severity and triage optimization | Development of a reliable score for triage and severity assessment |
Wide heterogeneity of prehospital sepsis care | - Consider early antibiotic therapy administration within 3 h (or even as soon as possible in patients with high likelihood for sepsis) after sepsis recognition - Consider early hemodynamic optimization with prehospital mean blood pressure target of 65mmHg - Consider early dispatching a primary health caregiver to the scene to deliver immediate care if ambulance is not available | - Improve spatial census of public hospital services, transports availability, caregivers training and patient access to the out-of-hospital emergency care system - Promote early antibiotic therapy available in ambulance and prehospital EMS team vehicle for community (3rd generation cephalosporin) and nosocomial (piperacillin-tazobactam) respiratory, urinary, and digestive infections - Prehospital crystalloids fluid expansion based on dynamic hemodynamic parameters - Promote early prehospital norepinephrine administration to reach mean blood pressure target of 65mmHg - Promote early primary health caregiver dispatching to the scene to deliver care |
Admission to the emergency department or ICU admission | Immediate ICU admission or immediate life-saving emergency room in the ED admission or life-threatening emergency room admission | Educational and courses for prehospital EMS regulation call centers, prehospital emergency medical teams and ICU to facilitate admission |
Delays of sepsis recognition, severity assessment and treatment initiation due to ED overcrowding | Reduction of delays for sepsis recognition, severity assessment and treatment initiation in the ED | Promote sepsis rapid response teams development |
Delayed ICU admission due to a lack of beds | Adequate number of ICU beds | Promote public health and healthcare policies involvement to increase the number of ICU beds |
Low adherence to sepsis bundles | Maximising sepsis bundles adherence | Initial and refresher educational and courses for healthcare practitioners |
Rehabilitation practices variations between ICUs | Early rehabilitation within 3 days of ICU admission | Educational courses for ICU teams to initiate early rehabilitation |
Insufficient post-acute care resources | Agreement with best-practice guidelines | Improve issues understanding to better integrate interventions into the complex post-discharge setting |