Why sepsis cases are getting a closer look from EMS, hospitals

Sepsis is a dangerous and fast-moving medical condition that can take a life in a matter of hours.

Mary Lynn Bushong was one of its lucky victims.

She only lost a leg.

“I started out with some kind of infection in my foot,” the Taylors woman said.

“There was no scrape, no nothing. It was just really weird,” she said recently. “But it turned out there was an abscess that went into a bone infection, which went into sepsis from there.”

As the condition progressed, Bushong developed a fever. She couldn’t eat or drink for days. And she was sleeping round the clock.

Her husband, Larry, was advised to get her to the hospital as soon as possible. And before long, doctors were amputating her left leg below the knee to save her life.

“I was scared to death,” her husband said. “The doctors told us it could be very dangerous.”

Sepsis occurs when the body’s immune system overreacts to an infection, resulting in life-threatening inflammation that can cause tissue damage, organ failure and death, according to the U.S. Centers for Disease Control and Prevention.

More than 1 million Americans suffer from severe sepsis each year, CDC reports, and between 28 percent and 50 percent of them die.

“It has the highest mortality rate of any condition in the hospital,” said Dr. Saria Saccocio, chief medical officer at Bon Secours St. Francis Health System in Greenville. “It’s responsible for one out of three mortalities in hospitals across the country.”

Attacking the problem

So St. Francis has launched an initiative that aims to save lives by identifying and treating sepsis as early as possible, attacking the disease from several angles, said the hospital’s sepsis coordinator Brandi Giles.

First, because 83 percent of sepsis cases come in through the ER, a triage nurse assesses every patient there for the condition, she said.

Should they have certain symptoms, lab work is ordered immediately. And if those tests confirm sepsis, an alert is sent to various services in the hospital, such as radiology and housekeeping to prepare them in case a chest X-ray or a bed is urgently needed, she said.

The pharmacy and lab also are put on alert to prioritize a patient with sepsis, she said, and two nurses regularly monitor a list of patients who may be septic.

Another facet of the program is Code SIR – Sepsis Investigation Response – which empowers nurses anywhere in the hospital to prompt an investigation if they feel a patient may have sepsis, Giles said. So if a patient’s blood pressure plummets, for example, they first rule out sepsis because time is of the essence in treating the condition. And, IV antibiotics need to be started right away.

To reinforce the response, the staff has had special training in sepsis, Giles said, and home health-care workers have a specific care plan for sepsis patients who are released.

“Every member on the team, from the EMS paramedic to the nurse, doctor and tech, are trained in sepsis recognition and empowered to expedite the patients work up and treatment,” said Dr. Angel Rochester, chief of adult emergency medicine at GHS.

A recent report in the “Journal of Emergency Medical Services” focused on a study which showed that when EMS began IV antibiotics and fluids in the ambulance – about two hours earlier than they would have gotten them otherwise – the mortality rate was cut by 16 percent. This approach cut the hospital mortality rates to among their lowest levels and saved about $600,000 from reduced length of stay, according to the study.

‘The great masquerader’

Sepsis happens when the immune system goes into overdrive to fight an infection, setting off a cascade of chemicals that overloads the body and shuts it down, Saccocio said.

Symptoms include fever, shivering, extreme pain, clamminess, confusion, shortness of breath, and an elevated heart rate. It most often results from infections of the lungs, urinary and gastrointestinal tracts, and the skin, according to CDC.

It’s the most expensive condition treated in the United States, costing more than $20 billion in 2011, according to the Agency for Healthcare Research and Quality.

Anyone can get sepsis, Saccocio said.

But people with a weakened immune system, for instance those with cancer, the elderly, and people taking immune-suppressing medications are at increased risk, she said. According to CDC, more than 90 percent of adults and 70 percent of children with sepsis have an underlying health condition.

And it’s been increasing in the United States largely because people are living longer, there’s been a rise in antibiotic-resistant bacteria, and an uptick in the number of invasive procedures, immunosuppressive drugs and chemotherapy used, according to CDC.

Roughly 10 percent of patients at St. Francis have sepsis, Saccocio said. And one of the challenges for health care providers is that a patient can appear to have a touch of pneumonia and in a matter of hours be overwhelmed by sepsis.

“We call it the great masquerader,” she said. “You can look fine coming in the door ... but you can quickly progress.”

So people need to know that their survival depends on getting immediate care, she said.

“It’s important to get the message out to the community just how serious sepsis is, how quickly it creeps up,” she said. “If you feel you have an infection, fever, shortness of breath with a cough, signs of pneumonia or a (urinary tract infection), any type of infection you’re not able to get control of, you need to go see a doctor.”

‘A learning experience’

Bushong’s problems began during the summer of 2015 when her foot and ankle became painful and swollen. She saw the doctor in September who concluded she had cellulitis, an infection of the skin and underlying tissues.

While she did what she could, it just got worse. And by the end of February, her condition had deteriorated significantly.

Doctors told her that they could try to save the leg, but it would involve a year of antibiotics with no guarantees that amputation wouldn’t still be necessary.

Bushong decided to “get it over with.”

Larry was nervous throughout the surgery, which took longer than expected.

“The thing you don’t realize, too, is how it (sepsis) affects all the other organs,” he said. “Once it gets going, it compounds itself.”

While it was a bit frightening at first, Bushong said she was all right after she turned it over to God.

“When I started to get kind of bad, I just said, ‘This is all up to you God,’ ” she said. “I’m content to rest in whatever you say.”

Between the surgery and rehab, she was hospitalized for 10 days. Then last month, after the wound had healed sufficiently, she was given a prosthetic leg, which she’s been learning to use.

Bushong said she’s now doing much better and truly feels blessed to have survived.

“I’d heard of sepsis before. But it’s one of those things you never think you’re going to get to experience,” she said. “It’s been a learning experience.”

This story was originally published November 18, 2016 at 1:44 PM with the headline "Why sepsis cases are getting a closer look from EMS, hospitals."