Early detection of sepsis—the emergency services’ perspective: Challenges in diagnosis and treatment

Sepsis is a life-threatening (multi)organ dysfunction caused by the host’s immune overreaction to an infection. Contrary to other important prehospital events such as out-of-hospital cardiac arrest, severe trauma, myocardial infarction or stroke, sepsis is difficult to diagnose and often lacks precise algorithms for diagnosis and treatment. Thus, the diagnostic pathway and rapid initiation of a goal-directed therapy are often delayed. Since publication of the revised Sepsis-3 criteria, qSOFA is the recommended screening tool for sepsis and includes the following three elements: level of consciousness, respiratory rate and systolic blood pressure. Sepsis bundles (diagnostic tests and therapeutic measures within certain time limits) should also be implemented in the prehospital environment. However, changes are necessary concerning diagnostic algorithms and prehospital logistics. Additional diagnostic tests such as a bedside lactate level or end-tidal CO measurements may also further improve future prehospital sepsis diagnosis.