Emergent Medicine: Impact of Out-of-Hospital Red Lights and Sirens (RLS) on Time to Antibiotic Administration in Sepsis Alert Patients

ABSTRACT

Study Objectives: This study asks whether the use of red lights and sirens while transporting patients identified as out-of-hospital 'sepsis alerts' impacts the time to antibiotic administration. Emergency Medical Services (EMS) personnel use emergent transport-characterized by the use of red lights and sirens (RLS)-for those patients deemed 'critical' or in need of potentially life-saving interventions beyond the scope of the interventions available in the out-of-hospital scenario. Nationally, the use of RLS saves ~90 seconds in urban EMS settings, which may be the difference between life and death in a cardiac arrest, traumatic hemorrhage or airway emergency. However, the decision to transport with RLS is often at the discretion of the EMS personnel without formal guidelines or evidence-based recommendations. Emergent transport is associated with increased risk of motor vehicle collision (MVC), injuries to EMS personnel and/or patients and property damage. Additionally, RLS in transport may detrimentally impact the patient's physiological and psychologic response to EMS transport. Sepsis is a life-threatening systemic response to infection, leading to shock or death if not treated with antibiotics. After receiving initial resuscitation in the field, it is common for 'sepsis alert' patients to be transported to the hospital emergently with the use of red lights and sirens (RLS). Upon arrival to the hospital, antibiotics may not be given for prolonged periods of time. Out-of-hospital antibiotic administration has shown little to no difference in patient outcomes either. These findings question the value of emergent transport of out-of-hospital sepsis alert patients, particularly when patients transported with lights and sirens have ~2.4 times higher risk of MVC. Method(s) This is a prospective, non-randomized controlled trial evaluating the clinical impact of emergent transport for patients identified as out-of-hospital sepsis alerts and transported by the Sarasota County Fire Department (SCFD) using either RLS on even days or no RLS on odd days. The time to antibiotic administration was analyzed by the priority of transport. Absolute time to antibiotic administration was calculated in minutes and analyzed using two-tailed T-tests in Excel and SPSS. Patients who tested positive for COVID-19 were removed from the data analysis. Result(s) Data collection ran from May to October of 2021, with an total sample of 709 patients identified as out-of-hospital sepsis alerts. Preliminary data from June to July 2021 showed an average time to antibiotic administration of 112 minutes for emergent versus 125 minutes for non-emergent (n = 84;p-value = 0.448). The average difference in transport time between emergent and non-emergent transports was only 91 seconds. Conclusion(s) There was a marked but non-significant difference in time to antibiotic administration for patients identified as out-of-hospital sepsis alerts and transported with or without RLS in our preliminary analysis. This difference cannot be explained by the time saved using emergent transport. Regional prevalence of COVID-19 cases during the study may have increased the variability in time to antibiotic administration. The absolute time of transport cannot account for the observed difference in time to antibiotic administration and hints that other variables determine the expediency of care for out-of-hospital sepsis alerts seen in the emergency department. [Formula presented] No, authors do not have interests to disclose Copyright © 2022