Treating sepsis in the emergency prehospital setting with IV antibiotics

Abstract

Background: The effectiveness of intravenous (IV) antibiotics for the treatment of sepsis in UK prehospital emergency care is not fully understood. In addition, the views of the key clinical decision-makers in ambulance services have not been documented. Aims: This study aimed to provide contemporary, primary data on the opinions of medical directors from across the UK on the use of IV antibiotics to treat sepsis in prehospital emergency care. Methods: A qualitative methodology was used. During semi-structured telephone interviews, participants were encouraged to share their personal and professional views on the use of IV antibiotics to treat sepsis in ambulance services. The interviews were recorded and transcribed, and a thematic content analysis using the principles of grounded theory was carried out. Findings: Five themes emerged: barriers and enablers; early sepsis recognition; accurate and consistent National Early Warning Score (NEWS) scoring; the need for primary evidence; and standardisation of equipment and protocols. A range of opinions were suggested, with an emphasis on rapid transfers and the need for further evidence. Conclusion: There is a drive for early sepsis diagnosis and pre-alerting the receiving hospital. However, there are potential barriers to standardising the approach if paramedics were to collect blood samples and administer IV antibiotics. Additionally, in the absence of UK data on the effectiveness of this treatment, many key decision-makers are reluctant to consider it as a standard approach. Despite this, there is some strong support for using benzylpenicillin for the treatment of suspected sepsis.