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  • 1.
    Axelsson, Christer
    et al.
    University of Borås, Faculty of Caring Science,Working Life and Social Welfare,The Prehospital Research Centre of Western Sweden,Borås,Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science,Working Life and Social Welfare,The Prehospital Research Centre of Western Sweden,Borås,Sweden.
    Karlsson, Anders
    Ambulance Service Sothern,Älvsborg Hospital,Borås,Sweden..
    Sjöberg, Henrik
    Ambulance Service Sothern,Älvsborg Hospital,Borås,Sweden..
    Jiménez-Herrera, Maria
    Nursing Department,Universitat Rovira I Virgili,Tarragona,Spain.
    Bång, Angela
    University of Borås, Faculty of Caring Science,Working Life and Social Welfare,The Prehospital Research Centre of Western Sweden,Borås,Sweden.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science,Working Life and Social Welfare,The Prehospital Research Centre of Western Sweden,Borås,Sweden.
    Bremer, Anders
    University of Borås, Faculty of Caring Science,Working Life and Social Welfare,The Prehospital Research Centre of Western Sweden,Borås,Sweden.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science,Working Life and Social Welfare,The Prehospital Research Centre of Western Sweden,Borås,Sweden.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics.
    Ljungström, Lars
    Infektion Disease Department,Skaraborg Hospital,Skövde,Sweden.
    The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting2016In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 31, no 3, p. 272-277Article in journal (Refereed)
    Abstract [en]

    Purpose There is a lack of knowledge about the early phase of severe infection. This report describes the early chain of care in bacteraemia as follows: (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start of intravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter. Basic Procedures All patients in the Municipality of Gothenburg (Sweden) with a positive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey. Main Findings/Results In all, 696 patients fulfilled the inclusion criteria. Their mean age was 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had "true pathogens" in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms and signs. The EMS nurse suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes versus three hours and 21 minutes among the remaining patients (P =.0006). The corresponding figures for cases with "true pathogens" were one hour and 19 minutes versus three hours and 15 minutes (P =.009).

    CONCLUSION: Among patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms and signs. The EMS nurse suspected sepsis in six percent of cases. Regardless of whether or not patients with true pathogens were isolated, a suspicion of sepsis by the EMS clinician at the scene was associated with a shorter delay to the start of antibiotic treatment. Axelsson C , Herlitz J , Karlsson A , Sjöberg H , Jiménez-Herrera M , Bång A , Jonsson A , Bremer A , Andersson H , Gellerstedt M , Ljungström L . The early chain of care in patients with bacteraemia with the emphasis on the prehospital setting. Prehosp Disaster Med. 2016;31(3):1-6.

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