You show up to a call for weakness and fever. The patient is 74. She’s had a cough for a few days and now seems confused. Her skin is warm, flushed, and damp. Her heart rate is 112. BP is 96 systolic. She’s breathing 26 times a minute.
Is this just the flu? Or is this patient slipping into a potentially fatal spiral known as sepsis?
As EMS providers, we are often the first point of medical contact for septic patients. The trouble is early sepsis can look like a hundred other things. Fatigue, flu, UTI, dehydration. But when you know what to look for and what to do, you can dramatically improve patient outcomes.
What Exactly Is Sepsis and Why Should EMS Providers Care?
Sepsis is the body’s over-the-top dramatic AF response to an infection. Instead of just fighting germs, the immune system sets off a full-body alarm. Blood vessels leak. Organs get starved. Tissues swell. And if left unchecked, everything can begin to shut down.
Sepsis kills about 1 in 3 people who develop it. In 2017 alone, sepsis affected approximately 49 million people and caused 11 million deaths globally. Nearly 1 in 5 deaths worldwide [1]. In the United States, mortality rates for sepsis vary based on severity: about 5.6% for uncomplicated cases, 14.9% for severe sepsis, and over 30% for septic shock [2].
Why does EMS care? Because early recognition is the only reliable way to reduce mortality. We’re in the perfect position to spot the warning signs, sometimes before the hospital even suspects it.
How Infection Turns into a Life-Threatening Emergency
Sepsis starts when an infection spreads beyond its original site. The immune system responds by releasing inflammatory chemicals into the bloodstream. Normally, this helps kill bacteria. But in sepsis, that response becomes chaotic.
Here’s what happens step-by-step:
1. Infection starts in the lungs, skin, urinary tract, or another source
2. Cytokines and mediators trigger systemic inflammation
3. Blood vessels dilate and leak, dropping blood pressure and perfusion
4. Clotting factors activate inappropriately, causing microvascular clots
5. Oxygen fails to reach tissues, leading to organ dysfunction or failure
If untreated, this cascade ends in septic shock and eventually death.
The earlier you interrupt that chain, the better the patient’s odds [1, 3].
SIRS vs qSOFA: What Providers Actually Need to Know
Two acronyms dominate in the world of sepsis screening: SIRS and qSOFA. Both help predict risk. Let’s translate these terms in plain language.
SIRS (Systemic Inflammatory Response Syndrome): You need two or more of the following:
• Temp >100.4 or <96.8
• HR >90
• RR >20
• WBC >12,000 or <4,000 (hospital labs only)
SIRS is very sensitive but not specific. That means it catches a lot of cases, but it also flags people who aren’t septic [4].
qSOFA (Quick Sequential Organ Failure Assessment): This is used outside the ICU to predict bad outcomes.
You need two or more of:
• RR ≥22
• Altered mental status (GCS <15)
• SBP ≤100 mmHg
qSOFA is more predictive of mortality but misses early cases. In fact, a recent study showed qSOFA had a better predictive value for 10-day mortality than SIRS, but both tools have limitations [5].
Best practice? Use your clinical judgment and protocols with these tools as guides. Not gospel. Look at the whole picture, especially vital trends and history.
Common Triggers of Sepsis in EMS Calls
Infection can start anywhere, but these are the most common culprits EMS should keep on the radar:
| Source | Clues in the Field |
|---|---|
|
Lungs |
Cough, wheezing, low O₂ saturation, fever |
|
Urinary |
Burning, foul-smelling urine, confusion |
|
GI Tract |
Nausea, vomiting, diarrhea, abdominal pain |
|
Skin/Wounds |
Cellulitis, abscess, recent injury |
|
Lines/Devices |
Foley catheter, PICC line, trach |
The elderly, immunocompromised, diabetics, cancer patients, and post-surgical patients are especially high risk. Sepsis-related death rates are especially high among adults over 65. In the U.S., those aged 85 and older have a sepsis mortality rate over 750 per 100,000 people [6].
Early Signs You Should Never Ignore
These signs don’t always scream “sepsis” but should trigger your spidey-provider senses, especially in combination:
• Tachycardia with hypotension
• Altered mental status with fever
• High respiratory rate (>22)
• Cool extremities and poor cap refill
• Hyperglycemia in a non-diabetic
• Recent infection or antibiotic use
• History of cancer, transplant, or steroid use
EMS might only see the beginning of a steep downhill slide. That’s why documentation and early suspicion are everything.
Documenting, Communicating, and Escalating Concern
If you suspect sepsis, don’t bury the lead.
- Notify the receiving hospital
- Document timing of symptoms, vitals, and any antibiotics or recent infections
- Provide a full med list
- Be direct: “I’m concerned about early sepsis”
A good handoff can mean the difference between a broad-spectrum antibiotic within 15 minutes or a delayed response that costs critical time [3].
Sepsis is sneaky. It can look like the flu, feels like fatigue, and can kill in hours. As EMS professionals, we have the tools to catch it early. But only if we’re actively looking for it.
You don’t need lab work to raise the red flag. You need good eyes, a working brain, and the courage to trust your clinical gut. When in doubt, speak up.
Stay tuned for Part 2 in this series, where we’ll break down the ugly inner workings of the cytokine storm and how sepsis takes over the body.
References:
1. Rudd, K.E. et al. (2020). Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. The Lancet. https://doi.org/10.1016/S0140-6736(19)32989-7
2. Paoli, C.J. et al. (2018). Epidemiology and costs of sepsis in the United States. Critical Care Medicine. https://journals.lww.com/ccmjournal/Fulltext/2018/12000/Epidemiology_and_Costs_of_Sepsis_in_the_United.1.aspx
3. Seymour, C.W. et al. (2017). Time to treatment and mortality during mandated emergency care for sepsis. New England Journal of Medicine, 376, 2235–2244.
4. Singer, M. et al. (2016). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. https://jamanetwork.com/journals/jama/fullarticle/2492881
5. Freund, Y. et al. (2017). Prognostic accuracy of sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2612305
6. CDC National Center for Health Statistics (2021). Sepsis-related mortality in adults aged 65 and over: United States, 2019. https://www.cdc.gov/nchs/products/databriefs/db422.htm
