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EMS: A Year in Review

Identifying and Treating Sepsis

In this year-end review, we highlight seven concerns that EMS experts say influenced their training in 2017.


Despite an increased focus on preventing infection, sepsis continues to be a leading cause of in-hospital death.1  For those sepsis patients who enter via the emergency department (ED), approximately half are transported there by EMS.2 Because of this, EMS plays an integral part in identifying sepsis early and administering antibiotics.

Each year in the United States, more than 1.5 million people get sepsis and 250,000 people die from it. 3

In the last few years, the Surviving Sepsis Campaign has pushed to identify sepsis early and begin rapid treatment to decrease mortality.4 One study by Greenville County EMS (GCEMS) in South Carolina found that antibiotic therapy within the first hour of severe sepsis recognition contributed to an eighty percent survival rate.5 These findings motivated the GCEMS system to develop an assessment and treatment protocol for paramedics and EMTs in the field. When applied, this protocol resulted in the lowest patient mortality due to sepsis in the hospital system’s history.

The GCEMS experience points to an opportunity for other EMS systems to make a large impact.

It can be challenging for paramedics to identify sepsis because they don’t have the same laboratory and imaging access that is available to physicians in the ED. However, some evidence has suggested that effective EMS sepsis recognition only requires the provider to evaluate respiratory rate, heart rate, temperature, and the possibility of an infection.6

While measuring lactate can be useful in gauging the severity of sepsis, it may not be necessary to recognize sepsis and begin treatment.

Experts recommend training EMTs and Paramedics to identify sepsis by facilitating three specific simulation scenarios:

  • Standard sepsis
  • Differentiating sepsis or pneumonia from the flu
  • Septic shock.7

These three scenarios in particular have been identified to ensure a more comprehensive patient assessment and more rapid treatment of septic patients.

Pre-programmed scenarios can provide the benefit of standardization among all EMS providers. Simulation-based training might provide the means for basic and advanced EMS providers to train in diagnosing sepsis faster and more accurately.


  1. Walchok, J.G., Lutz, M.E., & Pirrallo, R.G. (2016). South Carolina EMS integrates in-hospital sepsis care into protocols. Retrieved from
  2. Green, R.S., Travers, A.H., Cain, E., Campbell, S.G., Jensen, J.L., Petrie, D.A., et al. (2016). Paramedic Recognition of Sepsis in the Prehospital Setting: A Prospective Observational Study. Emergency Medicine International2016. DOI: 10.1155/2016/6717261
  3. Centers for Disease Control. (2017). Making health care safer. Retrieved from
  4. Walchok, J.G., Lutz, M.E., & Pirrallo, R.G. (2016). See reference #1.
  5. Ibid
  6. Dix, A. (2017). 3 scenarios to train for diagnosis, treatment of sepsis. Retrieved from
  7. Ibid

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