Paramedic Initiated Treatment of Sepsis Targeting Out-of-hospital Patients (PITSTOP)

The ultimate goal of this research program is to evaluate a fundamental change in the delivery of sepsis care. Currently, patients with severe sepsis do not receive key evidence-based therapies until they have been assessed in emergency departments - often introducing considerable delays. This research tests whether integrating paramedics directly into a chain-of-survival for sepsis will improve outcomes for these critically ill patients. In essence, this research seeks to break down silos of care, delivering sepsis treatments based on when they are needed, rather than on where the patient is physically located. If the trial is positive, the results will have broad implications for other health systems by showing that prehospital identification and treatment of sepsis increases the number of patients that survive this life-threatening condition. If the trial fails to demonstrate effectiveness of prehospital sepsis treatments, it will ensure that resources are not needlessly invested in large-scale implementations of paramedic sepsis protocols, as has been done in several other jurisdictions. A lack of benefit would also cast doubt on the observational data suggesting that early antibiotics are important, and suggest a more restrained approach to empiric antibiotic therapy.

Inclusion criteria

• Patients with Sepsis, defined as (all 3 must be present): i) Paramedic suspects possible infection: e.g. suspected pneumonia, urinary tract infection, skin infection, bone and joint infection, intra-abdominal infection, meningitis ii) Presence of fever: Temperature ≥ 38.0°C measured by paramedic or history of fever during previous 24 hours iii) Presence of hypotension: Systolic blood pressure < 100mmHg
• Age ≥ 18 years

Exclusion criteria

• Post cardiac arrest
• Suspected ST-segment elevation myocardial infarction (STEMI)
• Suspected acute cerebrovascular accident (CVA)
• Acute severe trauma
• Obvious severe non-traumatic bleeding
• Signs of fluid overload
• Suspected acute congestive heart failure (CHF)
• Known Clostridium difficile infection within the last 6 weeks
• Known pregnancy or breastfeeding
• Known allergy or sensitivity to penicillin or cephalosporin
• Known to be receiving oral or subcutaneous anticoagulants or low molecular weight heparin
• Paramedic is unable to identify patient by first and last name and/or health card number