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  • 1. Ambjörnsson, Joakim
    et al.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Strömsöe, Annelie
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Prehospital suspicion and identification of adult septic patients: Experiences of a screening tool2016Conference paper (Refereed)
    Abstract [en]

    Introduction: Sepsis is life threatening and requires urgent healthcare to reduce suffering and death. Therefore it is important that septic patients are identified early to enable treatment.

    Aim: To investigate to what extent EMS personnel identified patients with sepsis using the “BAS 90-30-90” model, and to describe assessments and medical procedures that were undertaken by the personnel.

    Methods: This was a retrospective study where 185 EMS medical records were reviewed. The inclusion was based on patients who were later diagnosed with sepsis in the hospital.

    Results: A physician assessed the patients in 74 of the EMS cases, which lead to exclusion of these records in regard to the EMS personnel’s ability to identify sepsis. The personnel documented suspicion of severe sepsis in eight (n=8) of the remaining 111 records (7.2%). The proportion of patients ˃65 years of age was 73% (n=135) of which 37% (n=50) were over 80 years old. Thirty-nine percent (39%, n=72) were females. The personnel documented blood pressure in 91% (n=168), respiratory rate in 76% (n=140), saturation in 100% (n=185), temperature in 76% (n=141), and heart rate in 94% (n=174) of the records. Systolic blood pressure <90 mmHg was documented in 14,2% (n=24), respiratory rate ˃30 in 36% (n=50), saturation <90 in 49%  (n=91), temperature >38°C in 37.6% (n=53), and heart rate ˃90 in 70% (n=121) of the records. Documented medical procedures and treatments were intravenous lines (70%, n=130), intravenous fluids (10%, n=19) and administration of oxygen (72%, n=133).

    Conclusion: The EMS personnel identified only a few septic patients with the help of the BAS 90-30-90 model when all three criteria would be met for severe sepsis. Either advanced age (>65 years), fever (>38°C) or tachypnea (˃20 breaths/min) appeared to increase the personnel’s suspicion of sepsis. Oxygen, but not intravenous fluids, was given in an adequate way.

  • 2.
    Andersson, Henrik
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Larsson, Anna
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Gellerstedt, Martin
    Bång, Angela
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ljungström, Lars
    The early chain of care in bacteraemia patients: Early suspicion, treatment and survivalin prehospital emergency care2018In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171Article in journal (Refereed)
    Abstract [en]

    Introduction: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim ofthis study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chanceof survival during the subsequent 28 days after admission to hospital. Furthermore, the long-term outcome wasassessed.

    Methods: This study has a quantitative design based on data fromEmergencyMedical Services (EMS) and hospitalrecords.

    Results: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28 days. TheEMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis alreadyon scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code “fever, infection”more frequently for survivors upon arriving on scene. The delay time fromcall to the EMS and admission to hospitaluntil start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%.Five-year mortalitywas 62.6% among those who used the EMS and 29.5% among those who did not (p b 0.0001).

    Conclusion: This study shows that among patientswith bacteraemiawho used the EMS, an early suspicion of sepsisor fever/infection was associated with improved early survival whereas the delay time from call to the EMSand admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were deadafter five years.

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