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