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Could giving antibiotics in the pre-hospital environment improve outcomes for patients with severe sepsis? A literature review

Posted on 8th August 2019 by

Evidence Reviews
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During the final year of their Paramedic Science (BSc Hons) course at Oxford Brookes University, students carry out a literature review and critical appraisal of a topic relevant to their future practice.  This blog presents the abstract of a literature review on ‘Giving antibiotics in the pre-hospital environment for patients with severe sepsis?‘.   Other Paramedic topic blogs can be found here.


Aim

The aim of this review is to explore the potential benefits of improvements to pre-hospital sepsis care, specifically to discover if the use of antibiotics for severe sepsis in the pre-hospital environment will improve patient outcomes.

Method

This review takes the form of a good standard literature review, following a systematic approach. A systematic search was undertaken, followed by critical appraisal of the identified papers. The available research was used to highlight key themes relating to the research question.

Results

The key themes identified included the quantity of  EMS use for septic patients, disease severity, paramedic education and training, time to antibiotic administration for EMS patients, and the effect of treatment changes on patient mortality. Although there was some key evidence highlighted, overall available research was limited. It was possible to identify an increase in use of EMS for patients with worse disease severity, although EMS patients usually received antibiotics quicker than non-EMS patients. Despite this, mortality rates were not improved for these patients, even when results were adjusted for disease severity.

Discussion

The available research, whilst highlighting the key themes, did not always provide clear answers to the initial question. There appears to be limited research which is completely focussed on use of antibiotics for severe sepsis in the pre-hospital environment. Whilst the evidence provided is useful to draw some conclusions, it is not of the strength that would be required to change best practices within the paramedic profession.

Conclusion

Further research is required before definitive conclusions can be drawn. Research must provide clear evidence that patient outcomes can be improved before a change of practice can be recommended. Additional research must be primarily focussed on the use of antibiotics in the pre-hospital setting.

Links out to PDF file of full review table

Links out to PDF file of full review table

Links out to PDF of full review table

Key Themes. 1: Degree of EMS involvement in sepsis patients. 2: Disease severity in EMS sepsis patients. 3: Recognition of sepsis by EMS. 4: Time to antibiotics (TTA). 5: TTA (and other treatments) effects on mortality.

References (pdf)

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Erika Winch

Erika has just completed her final year as a Paramedic Science student at Oxford Brookes University having previously qualified as a Nurse. View more posts from Erika

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  • Sarah

    I am looking to access the article below for a research dissertation however unable to access through my institution. Would you be able to forward me the PDF via email if you still have it?

    9. Walchok, J., Pirrallo, R., Furmanek, D., Lutz, M., Shope, C., Giles, B., Gue, G., Dix, A. (2017). Paramedic-Initiated CMS Sepsis Core Measure Bundle Prior to Hospital Arrival: A Stepwise Approach. Pre-hospital Emergency Care. 21 (3), 291-300.

    Thank you so much,

    17th June 2020 at 12:29 am
    Reply to Sarah

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