KnowEMS Webinar | Pre-Hospital Management of Sepsis

Overview

Hosted on April 4, 2025, the session featured an in-depth overview of sepsis physiopathology by Professor Leo Latasch, who highlighted the global impact and diagnostic challenges of sepsis. Presentations from Spain and Portugal detailed innovative identification scales and treatment approaches, while insights from Israel focused on fluid resuscitation practices and early antibiotic administration.

Panel discussions emphasized the future of sepsis management, addressing public awareness, the role of technology in fluid responsiveness and alarm systems, and challenges regarding blood cultures in hospital transfers. Final remarks focused on ethical considerations regarding resource allocation in ICUs based on patient frailty. Action items included sharing the webinar recording and resources for continued engagement.

Topics

Prof. Dr. Leo Latasch: "Sepsis Unveiled: The Physiology and Pathology"

• Sepsis is defined as a disease with an inflammatory response that stimulates complex interactions between endothelial complements and coagulation abnormalities.
• In 2017, sepsis caused 11 million deaths worldwide, accounting for nearly 20% of all global deaths.
• Septic shock has mortality rates up to 60%.
• Hyperinflammation causes a cytokine storm, damaging the endothelium and leading to dysregulated vascular tone and impaired permeability.
• Major diagnostic challenges include non-specific clinical symptoms, lack of a sufficiently sensitive biomarker, and the syndrome's lack of a unifying cause.
• Assessment tools presented: SOFA, SIRS, and qSOFA.
• Treatment includes fluid resuscitation (crystalloids preferred over saline), vasopressors, and time-sensitive bundles of care.

Paloma Rey Paterna: "Prehospital Management of Patients with Suspected Sepsis"

• Represented SAMUR Civil Protection (Madrid EMS) in place of Dr. Kapil Laxman Nanwani.
• Emergency medical services respond to approximately 40% of all septic patients.
• Reviewed three main scales for sepsis identification: PRESEP, qSOFA, and NEWS 2.
• NEWS 2 showed better sensitivity, accuracy, and negative predictive value than qSOFA.
• Lactate measurement is the most used biomarker in their practice.
• SAMUR protocol activates 'Code 3.18' when two of the first three factors are associated with fever.
• Protocol includes IV access for crystalloids, oxygen, and blood gas analysis.

Dra. Maria Adelaide Esteves (INEM): "Portuguese Sepsis Care Process in Prehospital Setting"

• In Portugal, sepsis incidence is growing by 1.5% each year.
• Sepsis is the admission diagnosis in 22% of ICU admissions, with a 40% hospital mortality rate.
• Portuguese pre-hospital intervention is based on national guidelines from 2016/2017.
• In 2023, criteria were modified to increase sensitivity: temperature change OR focal symptoms WITH systemic inflammation OR severity criteria.
• Their IT application (iTIMS) launches a sepsis alarm automatically when information is properly filled.
• Blood cultures and antibiotics are not available in Portuguese pre-hospital settings.
• The CODU coordinating doctor manages alarms, can dispatch additional teams, and refers patients to appropriate hospitals.

Mr. Tomer Kaplan (MPh): "Innovation in Sepsis Management in the Pre-Hospital Setting"

• MDA (Magen David Adom) focuses on early identification and aggressive treatment to reduce mortality.
• Hartman solution is preferred over saline for fluid resuscitation due to better outcomes and less risk of hyperchlorbic metabolic acidosis.
• Epinephrine (10-20 micrograms) is used for vasopressors as dopamine is no longer recommended.
• Fluid resuscitation: 30ml/kg in the first hour, given in 250-500ml boluses with close monitoring.
• Currently examining early administration of antibiotics in pre-hospital settings.
• Israeli Ministry of Health established KPIs for health system measurement.
• Sepsis KPI involves qSOFA scoring system with automated alerts when the score is ≥2.