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Prehospital Sepsis Project (PSP): Knowledge and Attitudes of United States Advanced Out-of-Hospital Care Providers

  • Amado Alejandro Báez (a1), Priscilla Hanudel (a2), Maria Teresa Perez (a3), Ediza M. Giraldez (a4) and Susan R. Wilcox (a5)...



Severe sepsis and septic shock are common and often fatal medical problems. The Prehospital Sepsis Project is a multifaceted study that aims to improve the out-of-hospital care of patients with sepsis by means of education and enhancement of skills. The objective of this Project was to assess the knowledge and attitudes in the principles of diagnosis and management of sepsis in a cohort of United States out-of-hospital care providers.


This was cross-sectional study. A 15-item survey was administered via the Web and e-mailed to multiple emergency medical services list-servers. The evaluation consisted of four clinical scenarios as well as questions on the basics of sepsis. For intra-rater reliability, the first and the fourth scenarios were identical. Chi-square and Fisher's Exact testing were used to assess associations. Relative risk (RR) was used for strength of association. Statistical significance was set at .05.


A total of 226 advanced EMS providers participated with a 85.4% (n = 193) completion rate, consisting of a 30.7% rural, 32.3% urban, and 37.0% suburban mix; 82.4% were paramedics and 72.5% had worked in EMS >10 years. Only 57 (29.5%) participants scored both of the duplicate scenarios correctly, and only 19 of the 193 (9.8%) responded to all scenarios correctly. Level of training was not a predictor of correctly scoring scenarios (P = .71, RR = 1.25, 95% CI = 0.39-4.01), nor was years of service (P = .11, RR = 1.64, 95% CI = 0.16-1.21).


Poor understanding of the principles of diagnosis and management of sepsis was observed in this cohort, suggesting the need for enhancement of education. Survey items will be used to develop a focused, interactive Web-based learning program. Limitations include potential for self-selection and data accuracy.

Báez AA, Hanudel P, Perez MT, Giraldez EM, Wilcox SR. Prehospital Sepsis Project (PSP): Knowledge and Attitudes of United States Advanced Out-of-Hospital Care Providers. Prehosp Disaster Med. 2013;28(2):1-3.


Corresponding author

Correspondence: Susan R. Wilcox, MD Zero Emerson Place, Office 3B Boston, MA 02114 USA E-mail


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1.Adrie, C, Alberti, C, Chaix-Couturier, C, et al. Epidemiology and economic evaluation of severe sepsis in France: Age, severity, infection site, and place of acquisition (community, hospital, or intensive care unit) as determinants of workload and cost. J Crit Care. 2005;20(1):46-58.
2.Brun-Buisson, C, Roudot-Thoraval, F, Girou, E, et al. The costs of septic syndromes in the intensive care unit and influence of hospital-acquired sepsis. Intensive Care Med. 2003;29(9):1464-1471.
3.Burchardi, H, Schneider, H. Economic aspects of severe sepsis: A review of intensive care unit costs, cost of illness and cost effectiveness of therapy. Pharmacoeconomics. 2004;22(12):793-813.
4.Martin, GS, Mannino, DM, Eaton, S, Moss, M. The epidemiology of sepsis in the United States from1979 through 2000. N Engl J Med. 2003;348(16):1546-1554.
5.Angus, DC, Linde-Zwirble, WT, Lidicker, J, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303-1310.
6.Rivers, E, Nguyen, B, Havstad, S, et al. Early Goal-Directed Therapy Collaborative Group: early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-1377.
7.Dellinger, RP, Carlet, JM, Masur, H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004;32(3):858-873.
8.Dellinger, RP, Levy, MM, Carlet, JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296-327.
9.Le May, MR, So, DY, Dionne, R, et al. A citywide protocol for primary PCI in ST-segment elevation myocardial infarction. N Engl J Med. 2008;358(3):231-240.
10.The National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Study Group. A systems approach to immediate evaluation and management of hyperacute stroke. Experience at eight centers and implications for community practice and patient care. Stroke. 1997;28(8):1530-1540.
11.Mulholland, SA, Cameron, PA, Gabbe, BJ, et al. Prehospital prediction of the severity of blunt anatomic injury. J Trauma. 2008;64(3):754-760.
12.Grossman, DC, Kim, A, Macdonald, SC, et al. Urban-rural differences in prehospital care of major trauma. J Trauma. 1997;42(4):723-729.
13.Carr, BG, Caplan, JM, Pryor, JP, Branas, CC. A meta-analysis of prehospital care times for trauma. Prehosp Emerg Care. 2006;10(2):198-206.
14.Gonzalez, RP, Cummings, GR, Phelan, HA, et al. Does increased emergency medical services prehospital time affect patient mortality in rural motor vehicle crashes? A statewide analysis. Am J Surg. 2008;197(1):30-34.
15.Brice, JH, Evenson, KR, Lellis, JC, et al. Emergency medical services education, community outreach, and protocols for stroke and chest pain in North Carolina. Prehosp Emerg Care. 2008;12(3):366-371.
16.Myers, RB. Prehospital management of acute myocardial infarction: Electrocardiogram acquisition and interpretation, and thrombolysis by prehospital care providers. Can J Cardiol. 1998;14(10):1231-1240.
17.De Lorenzo, RA, Abbott, CA. Effect of a focused and directed continuing education program on prehospital skill maintenance in key resuscitation areas. J Emerg Med. 2007;33(3):293-297.
18.De Lorenzo, RA, Abbott, CA. Effectiveness of an adult-learning, self-directed model compared with traditional lecture-based teaching methods in out-of-hospital training. Acad Emerg Med. 2004;11(1):33-37.
19.Hubble, MW, Richards, ME. Paramedic student performance: Comparison of online with on-campus lecture delivery methods. Prehosp Disaster Med. 2006;21(4):261-267.



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