title: The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting.
abstract: 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).
  
  
  CONCLUSIONS
  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):272-277.
authors.affiliation: 1Faculty of Caring Science,Working Life and Social Welfare,University of Borås,The Prehospital Research Centre of Western Sweden,Borås,Sweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Axelsson
authors.affiliation: 1Faculty of Caring Science,Working Life and Social Welfare,University of Borås,The Prehospital Research Centre of Western Sweden,Borås,Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
authors.affiliation: 2Ambulance Service Sothern,Älvsborg Hospital,Borås,Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Karlsson
authors.affiliation: 2Ambulance Service Sothern,Älvsborg Hospital,Borås,Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Sjöberg
authors.affiliation: 3Nursing Department,Universitat Rovira I Virgili,Tarragona,Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Jiménez-Herrera
authors.affiliation: 1Faculty of Caring Science,Working Life and Social Welfare,University of Borås,The Prehospital Research Centre of Western Sweden,Borås,Sweden.
authors.forename: Angela
authors.initials: A
authors.lastname: Bång
authors.affiliation: 1Faculty of Caring Science,Working Life and Social Welfare,University of Borås,The Prehospital Research Centre of Western Sweden,Borås,Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Jonsson
authors.affiliation: 1Faculty of Caring Science,Working Life and Social Welfare,University of Borås,The Prehospital Research Centre of Western Sweden,Borås,Sweden.
authors.forename: Anders
authors.identifier: http://orcid.org/0000-0001-7865-3480
authors.initials: A
authors.lastname: Bremer
authors.affiliation: 1Faculty of Caring Science,Working Life and Social Welfare,University of Borås,The Prehospital Research Centre of Western Sweden,Borås,Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Andersson
authors.affiliation: 4Faculty of Economy and IT,West University,Trollhättan,Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Gellerstedt
authors.affiliation: 5Infektion Disease Department,Skaraborg Hospital,Skövde,Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Ljungström
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy*; D003266:Continuity of Patient Care; D004632:Emergency Medical Services; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: ED emergency department; EMS Emergency Medical Service; Emergency Medical Services; RETTS Rapid Emergency Triage and Treatment System; SIRS Systemic Inflammatory Response Syndrome; bacteremia; prehospital phase; sepsis