Jackson Memorial Emergency Medicine Leadership Develops the Miami Prehospital Sepsis Alert

Jackson Memorial Hospital emergency medicine physicians have partnered with local emergency medical services (EMS) leaders to implement a Prehospital Sepsis Alert System, set to launch in September- Sepsis Awareness Month in September.

Sepsis is a condition that can result in organ damage or death when the body’s immune system has a severe response to an infection. It often leads to a fatal medical emergency; however, with early intervention, the likelihood of survival increases significantly.

According to the Centers for Disease Control and Prevention (CDC), sepsis has contributed to more than 6 percent of all deaths in the United States, and 80 percent of all sepsis cases start outside of the hospital, where time without care is directly related to an increase of mortality.

“The earlier you intervene and start therapeutic intervention, the better the patient’s outcomes will be,” said Amado Alejandro Baez, MD, MSc, MPH, FAAEM, FCCM, academic affairs and program director for Jackson Memorial Emergency Medicine Residency Program. “Having this collaboration with our EMS leaders will continue to hold Jackson at the forefront of excellent patient care.”

The Prehospital Sepsis Alert System is aimed at educating EMS first-responders of the warning signs of sepsis. Noticing those signs – a drop in blood pressure, chills and shaking, rapid heartbeat, shortness of breath; severe nausea or uncontrolled vomiting, confusion, dizziness, decreased urination, and severe pain—would allow EMS providers to begin treatment before arriving at the hospital.

Dr. Baez, the principal investigator for the Prehospital Sepsis Alert System, is confident this new system will lead to earlier intervention and more lives saved.

“The goal is to optimize patient care, “he said. “We have developed a data/evidence-based prehospital sepsis identification tool, the Miami Score, that we hope will improve the critical care continuum.”

The Miami Score tool is the polished product of the model Dr. Baez created at Harvard Medical School in 2008 when he was there as faculty. Harvard was the first in the nation to use this evidence-based prehospital tool, which successfully addressed critical and intensive care unit needs. The tool is based on a four-point system that evaluates patients on respiratory rate, fever, and shock index.

Depending on the patient’s score, EMS will determine what the best treatment plan is. The first three hours that a patient shows signs of sepsis are critical. During that timeframe, EMS providers can perform aggressive fluid resuscitation and provide antibiotics before arriving to the hospital’s emergency department.

Once in the emergency department, patients at risk for sepsis will be thoroughly examined by physicians. A series of tests will be completed, including blood and urine tests to check for a presence of bacteria or organ failure. X-rays may also be ordered and additional treatment options, such as antibiotics, oxygen and intravenous fluids, may begin.

Other hospital systems have contemplated having a prehospital sepsis alert in place, but the Miami Score Project at Jackson Memorial Hospital is the first nationwide to spearhead official implementation.

“The common denominator is the patient,” said Dr. Baez. “Similar to how we treat stroke, trauma and heart attack patients, care of patients with sepsis should start in the field.”