[The golden hour of sepsis: initial therapy should start in the prehospital setting]

Abstract

Background: Sepsis is a common, time-urgent emergency that is still associated with a high mortality and morbidity rate. A strong correlation between the onset of therapy and survival has been shown. With every hour of delay, survival decreases by 7.6 %. In 2001, four treatment goals that should be performed in the first 6 h of treatment were developed. These form the basis of early goal-directed therapy (EDGT) which is accepted as the standard of treatment for sepsis in the emergency department.

Objectives: More than half of patients are admitted to the hospital by medical emergency services. Up to 40 % receive prehospital therapy with i.v. fluids and stabilization of vital signs according to the goals of EDGT. The diagnosis of sepsis is difficult if characteristic symptoms or parameters such as in the ST segment elevation myocardial infarction are lacking. However, 90 % of patients present with fever.

Conclusions: Body temperature should always be assessed by paramedics. In addition, sepsis must always be considered as part of the differential diagnosis. If the suspicion cannot be ruled out, immediate therapy has to be initiated. Concerning the prehospital use of antibiotics, preliminary results of a study from the center of sepsis control and care in Jena, Germany, showed that this therapy form seems to be safe and effective, but further evaluation is necessary.