Ryan Mayfield

Dave, The paramedics are trained in the SIRS + Infection + Hypoperfusion (SBP or MAP or Lactate) model and call a sepsis alert if the patient meets these criteria. Lactate is just given as another form of hypoperfusion. Calling the alert allows the hospital to prepare for the arrival of the patient and the paramedics start fluid resucitation. As to the need, let me ask you this. How many of your septic shock patients are cryptic? We found that in our patient population it is around 30%. Add to that the majority of septic shock patients are brought in by EMS (I can cite my source if needed, but its too early to find the paper) and we think it makes sense. Published mortality rates for EGDT patients are around 33%, last year our hospital system was in the single digits if EMS identified the septic shock patient and called an alert. The biggest difference in mortality is seen in the cryptic patient subset. As for the price, its around $2-3 a test. Not free, but much less expensive than some. Thoughts? We are always looking to improve our process. Thanks, Ryan

We have been doing prehospital lactate as a part of identifying patients in septic shock since 2009. We have submitted our results and will hopefully be published soon. What we did find is that if EMS identifies the septic patient, even with a short transport, there is a decreased mortality, LOS, and intubation rates. It looks to have some of the biggest impact on cryptic sepsis were the patient is normotensive with an elevated lactate. I will be happy to share what we have learned with whoever wants to know. There are meters out there that are FDA approved and CLIA waived that can be bought online.