Fla. EMS Tests New Way to Detect Sepsis

May 04--Orange County paramedics and hospitals are among the first in the nation to create and use an alert system for sepsis, a condition that can lead to organ failure or death.

Sepsis is mostly identified in the hospital with blood tests, but local researchers are showing that paramedics can use a simple breath measurement to identify potential cases of sepsis in the field and prepare the hospitals for arrival of the patients.

Much like stroke, heart attack and trauma, every minute and hour counts when it comes to sepsis. But unlike stroke and trauma alerts, which have standard protocols for emergency responders and hospitals, there's no standard alert system for sepsis.

"Sepsis has a higher mortality rate than stroke and heart attack," said Dr. Christopher Hunter, associate medical director for Orange County EMS, who has been leading the research on the new sepsis alert system for more than five years.

"I think we're going to see more EMS systems start to go this direction and look at sepsis this way. We're among the first to focus on this," he said.

Hunter's latest study, published in the American Journal of Emergency Medicine, has caught the attention of organizations from across the nation and Canada. If its success is confirmed by larger studies, it could become a standard practice.

Based on the alert system, paramedics look for several physical symptoms such as signs of infection, rapid heart rate and fever, and a key indicator: the level of exhaled CO2, which has been shown to be an indicator of the severity of sepsis.

If all boxes are checked, "We move quicker," said Maria Diaconu, a firefighter paramedic with Orange County Fire Rescue. "We call the hospital and tell them there's a sepsis alert and start to give the patient fluids immediately. Once we get to the hospital the doctors are waiting for us. The bed is ready. They jump on the patient and start drawing blood."

Sepsis isn't an infection, nor is it a hospital-acquired condition. Sepsis happens when the body's immune reaction to an infection goes haywire and in an overwhelming response starts attacking tissues and organs.

Anyone with an infection can develop sepsis, but people with a weak immune system, babies and elderly, or people with chronic diseases are at a higher risk.

Less than an hour after being discharged from the hospital, Eugene Knutson was in an ambulance getting rushed back to the hospital.

He had gone in for surgery for an infection of his colon and was sent home with a slight fever. Soon after, his fever spiked and he started having severe chills.

"I had my wife and daughter put every blanket in the house on me and I was still cold," said the 65-year-old Spring Hill resident.

Surgeons told him he had developed sepsis and his chances of survival were small.

"I never realized the ramifications of sepsis until I was affected by it," said Knutson, a retired paramedic, who has had 28 more trips to the operating room since that fateful day in March 2011. "It's the most horrible feeling in the world. It's something I don't wish on my worst enemy."

The number of sepsis cases continues to increase for several reasons, including an aging population, growing number of people who live with chronic illnesses, increasing antibiotic resistance and better awareness and tracking of sepsis.

There are more than 1 million cases of sepsis in the United States each year and nearly 260,000 people die from it.

Studies have shown that the sooner septic patients are treated with fluids and antibiotics, the better they fare.

In other words, "Time is tissue," said Laurie Hiebert, critical care project manager at Florida Hospital.

Currently, the presence of a certain compound in the blood is used in the hospital to measure the severity of sepsis. But the process of drawing blood and measuring it can be time-consuming and in some cases face regulatory roadblocks since it has to be done in an EMS truck.

Hunter and his team are hoping that measuring exhaled CO2 will solve the problem.

Officials at Florida Hospital and Orlando Health have been working with Orange County EMS to implement the alert system. But there's more work to be done before this alert system catches on nationally.

"Having this as a possibility is very exciting," said Matt Zavadsky, a member of the board of directors at the National Association of Emergency Medical Technicians who is not involved in Hunter's studies. "But does it change the outcome. ... that's a tough chasm to cross."

The Orlando team is now analyzing patient data to see if the sepsis alert protocol indeed led to better survival rates. Early findings have been promising so far, Hunter said.

"Sepsis really is the biggest underrecognized health care problem we have when you look at infections and mortality rates," said Dr. Michael Taylor, who sits on the board of directors for the advocacy group Sepsis Alliance. "We wouldn't accept that for other diseases."

Sepsis is the ninth-leading cause of disease-related deaths and is among the most costly conditions in U.S. hospitals.

"If you go to the hospital for anything, tell every physician that you're concerned about sepsis and you want to be screened for it at every shift," advised Carl Flatley, who founded the Sepsis Alliance in 2003 after losing his 23-year-old daughter to sepsis following a simple surgical procedure.

"My daughter's case never should have happened," said the Tampa-based retired dentist.

nmiller@orlandosentinel.com or 407-420-5158

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