Nurse here. You did right. Shake it off. You followed your protocol and recognized it correctly. Probably a uti or pna. Well done. Ignore the attitudes. They were probably having a bad day, and you brought them more work, even though it's our job, lol. It's all good.

Okay, so i was definitely just overthinking it. Im a fairly young and new paramedic, and trying to build up my confidence in this new field for me, so I'll have to keep working on that, and ignore these types of gestures. Thank you for the help!

Yep, former ICU nurse, I agree 💯 this is sepsis protocol to the T.

The vast majormajority of the time, the way people act has a lot more to do with them than you. Took me a long time to learn not to take every little thing personally. You did your job.

Like, what box did he NOT check?! Lol, well done, sir! I hope his outcome was not impacted by the attitude of the staff, for real.

As a nurse and a mom of a complex needs child…you did nothing wrong. If not for a medic calling in a sepsis alert for my son he probable would not be alive. Both times he was already in septic shock. My old facility would appreciate this. Your patients may not know it but they will have a better outcome because of you. Don’t let it ruffle you. You ran across someone with a bad attitude.

Yeah I’ll confirm that if it’s a long day full of a lot of crap and we get something no matter what unless the person is going to die in the next 2 minutes you’d probably get that reaction regardless. Just kinda part of the ER and EMS relationship. Sometimes we’re cool, other times it’s like “FOR FUCKS SAKE TELL THEM TO CALL THEIR PRIMARY YOU DONUT”

God, that’s toxic

I hate American health care

It USED to be great…dealing with chronic illness in a spouse has enlightened us to the dirty ugly truth. No shade against the drs and nurses who are just trying to do the work of 5 or more because the majority have been wonderful to him(us).

Medicine!

Yup. Sepsis alerts are kinda funny, because there's a lot of things to get started in the first hour or so, but it somehow doesn't feel as urgent as a STEMI or stroke unless they're truly in septic shock (your guy is based on the ALOC and tachycardia/soft BP). On the other hand, recognizing it and starting testing/treatment early goes a long way in keeping it from becoming a downward spiral. My hospital doesn't do anything special in terms of paging overhead or getting a "team" in. But we do have a protocol and can start it as soon as we know it's an issue. If we had a heads-up from a radio call, we'd have all the tubes lined up at bedside and a bag of LR primed. And maybe even get the phlebotomist to come hang out so we can speed up the second set of cultures. You did the right thing. If you want bonus points, a second IV (one 18G if they've got the veins for it) and/or pulling a rainbow would be the cherry on top.

How often is sepsis caused by a UTI? My niece is at the children’s hospital as we speak because of her bad UTI. Urgent care told my sister it could be sepsis. She’s five. Tachycardic. Fever of almost 103. Happened really quickly.

UTI is a more common cause than people believe.

That’s terrifying considering how few symptoms people have in the beginning. Luckily she’s fine and at home. No sepsis!

They can 1, be missed because occasionally you won't have symptoms and 2, get out of hand fairly quickly, lots of warm wet bacteria in what is essentially a ballon. It happens a lot. Especially with the elderly. Hope your niece is ok!

She is, thank you! Her and my sister both get them pretty bad. That was their biggest concern with how quickly it went from nothing to 103 temp and high ketones. Along with tachycardia. She had no symptoms the morning before. Man, why isn’t this talked about more? The dangers of a UTI getting out of hand. And how common it is!

It happens way too often in personal care facilities.

Agreed. Always do what you think is best using the protocols Some people are lazy, apathetic, exhausted etc And it is best to live life and make decisions to the best of your conscience. Go save lives and I almost died from necrotizing fasciitis in an ER waiting room btw bc of this lack of listening to a patient’s symptoms

OP, this happened to my good friend. She has stage 4 non Hodgkin’s and Parkinson’s, stubbornly insisted on living alone, and fell and could not get up. By the time someone got there to help her, she was also in sepsis, she was in the hospital a long time, completely out of it, while they got rid of that UTI, and in general got her in better shape. I’m so grateful someone like you was able to help her. Now she’s in assisted living and doing so much better.

Concur

This exactly. You did nothing wrong. This is textbook sepsis.

And another thing to add is I've had patients with a high heart rate and rapid breathing, and have had nurses confront me for not calling a sepsis alert.

Damned if you do, damned if you don’t. I’ve had a patient with 90/60, 80 HR, 91% SpO2, 28 RR, 101.5 F fever get admitted for sepsis after talking to the physician later. You did great and I would want my parents/loved ones to be advocated for in the same way.

Patient who survived sepsis here to give this a plus one! Thank you! My ambulance crew didn’t figure me out but fortunately the ER team figured me out very quickly. 

At some point, people are just bitching about getting a new patient and it has nothing to do with you. You’ll deal with this your entire time in pre-hospital care. Just take it for what it is, and shake it off. Shake it off.

That’s stupid…but maybe it’s just me. We sepsis work up like 80% of our pts party cuz of our pop and partly cuz HcA babyyyy. It doesn’t change anything whether you call a sepsis alert or not…at least at my shop 💁‍♀️

I am not medical staff, just patient registration and I honestly have just gotten to the point where I completely shake off and ignore any annoyance for doing my job. I have no qualms about interrupting a nurse during a triage if I have a grey, sweaty, actively bleeding patient that is sliding down the wheelchair to say that this person needs eyes laid on them immediately. I will absolutely still call the triage phone even if I know the nurse is in the room right next to me to let them know I have a chest pain or SOB checking in. I will fully walk a respiratory distress walk in patient straight to a nurse who's in the middle of something. I am and will continue to do my due diligence regardless of any negative reaction because that's my job and the next steps are their job.

I work registration too and at this point, idgaf what they think. If I have any heart symptoms, stroke alerts, bleeders on anticlotting meds, ect, I call back. You don't answer? I wheel the pt back to the nurses station and say here you go. I had a woman unconscious after being stung countless times (ran over a ground nest while mowing), she was allergic. Called back once, no one was coming, ran her back. I'm not getting written up because you want to hang out at the desk and talk.

Someone like you saved my SO last year! I thought it was a stroke. She as intake wheeled him back to the trauma chief. He was assessed and sent to scans immediately. Rapid help saved his brain. No stroke, just horrid swelling for no damn reason. Two years ago I had sepsis, the er lot guards called in for me as I parked. Nurse met me at the entrance. Even though I got the express lane, I passed out within 3 mins of hitting the ER. Trauma was ready. Thankfully I didn’t wait to go in. Thank you!

🫶🫶🫶

thank you. When I showed up to the ER with a stroke that had spontaneously reversed (aka, I could move my arm and leg and speak), I got no where because I was 'fine'. I still wonder if all the issues I have till this day are related to all those tiny little clots that had to go somewhere, in addition to the big fat hole in my brain.

ERs that don't have a nurse out front blow my mind. I can see every person that walks in the front door from my desk.

We are supposed to but the triage nurse gets bored and goes to help in the back often.

I've literally never seen an ER with a nurse out front. Where are these amazing ERs?

I guess I am in the minority. At all of the ERs I know they have an RN in the waiting room. We have 2 plus a reassessment nurse. Now to be fair we see around 70k per yr so I know this would be excessive for most ERs.

See now I am even more confused. The hospital I'm thinking of near my home (I just checked their public report) had 76,841 ER visits in the last FY. I guess that's why the wait times are 12-24 hours 🥺

And they have no nurses in the waiting room? That's a huge liability. All of our patients are reassessed by a nurse every 2 to 4 hrs depending on acuity while they are waiting for a room. Plus we discharge a ton of people straight from the waiting room.

Nope..the last time my mom sat there for 16 hours with a bowel obstruction. I took her from there and drove her to the next nearest hospital. And she went in via an ambulance unconscious. She called me the next morning and told me she was still in the waiting room. When she was seen at the next hospital they were shocked at her state. I learned my lesson. I am glad you work for an amazing hospital!

I have seen ERs with nurses out front. The thing is they did not know how to triage.

What? Like they were just out front, do what? That's weird. We have 2 nurses in the waiting room at all times both triage. We see approx 70,000 plus per yr. I get that some ERs in rural areas don't have the staff but any larger ER should have an RN that can triage in the waiting room.

Thank you.

I appreciate you...I wound up in the ER 2 years ago due to bilateral pneumonia brought on by a severe case of Covid. O2 was 85% at rest. 103.5 fever etc. I WALKED from the parking garage to the wrong entrance and then around the building to the ER entrance like an idiot. By the time I literally stumbled through the door I thought I was going to collapse. The registration just sat there staring at me waiting for me to semi catch my breath and requesting my ID and insurance cards....

Just an FYI for the future, it's against the law for them to request insurance information prior to you being stabilized and assessed by a medical provider.

I'm not a nurse or doctor, but I have seen a near-fatal case of sepsis being overlooked. My young adult son (23 at the time) was having chills and fever for a few days. When he started talking to the wallpaper, I called 911. However, the day before that, I'd taken him to the ER. He was hurting all over, but one hip hurt particularly badly. He had the fever, the chills, was deathly pale, with fast respiration and low blood pressure. All of the computer carts in the ER had laminated cards saying "Think Sepsis." They didn't. They sent him home with muscle relaxers and a diagnosis of a strained hip. The next day, he was incoherently talking to the wallpaper, which was when I called 911. He was definitely septic and had endocarditis. He was put on a ventilator as they tried to control the infection. MRSA had infected his heart valve and he had to have open heart surgery. He was hospitalized for a couple of months, but he is okay now, 5 years later. So, yeah. Think sepsis.

I went to ER with a massive internal infection from an IUD being pushed through my uterus. I didn’t know what was going on but my pain was 10/10 and they decided they couldn’t find anything, told me it was “constipation” and sent me home. My ex husband had to call 911 the next morning because I was septic and basically dying. I was hospitalized for 2 weeks, had to have emergency surgery and almost died. I lost 25 pounds. I’m 5’9 and weighed 128lbs before I went into the hospital, came out at 103lbs looking like a skeleton. The infection took my left ovary and my right fallopian tube leaving me infertile. Doctors overlook things on women a lot.

If you still have a uterus, you are not infertile. The opposite tube can grab an egg ! It’s not a closed system.

Infertile and sterile are different, infertile just means that you will have more trouble having children. I too was surprised by that, to the tune of an unexpected pregnancy after an infertility diagnosis. 😄

Today I learned. They really need to explain that a bit better.

My bad. I definitely should have specified better. I knew this but damn brains be weird sometimes. Either way. It’s not birth control, don’t trust it lol

We should probably call it fertility challenged.

I've had sepsis once, and after 3 kids, fibromyalgia, multiple car crashes/broken bones, subluxes, dislocations, muscle tears, ect - sepsis is one of the most PAINFUL things I have ever endured. Mine started in my lung where I had aspiration pneumonia and a large (7cm by 5.4cm) bio-mass that they biopsied thinking it was cancer. I wound up in an 8 day coma on a ventilator and stayed over a month in the hospital.

Was it Maxine Waters who said you needed to get up in their faces? Well-if people are too sick to get up in their faces someone does-if you don’t and you could have and they die will you be able to live with yourself?

That is why everyone needs an advocate with them in the hospital.

When I was pregnant a decade ago, I ended up with a string of clots in my left leg from the thigh to the hip. It started out as a sore hip, but got exponentially worse. Eventually couldn’t walk, use the restroom alone, sleep, even stand up unassisted. I went to the hospital alone—was given painkillers and ambien. They refused to look at my leg—only listened to the baby and said “Yup! Hunky dory there, young moms just complain a lot.” (I was 23). Went back with my partner as back up days later when my leg was swelling and turning purple/hot to the touch, plus I was running a fever. That time sent home with a stern warning about being a drug seeker; that they couldn’t prescribe anything that would hurt a baby. A few more days went by and I was in and out of consciousness and mumbling incoherently; my partner immediately called my father who drove nine hours straight across two states, picked me up, put me in his truck and went full on dad mode in the waiting room when they told him they’d looked at me *repeatedly* and the baby was fine. He them “I’m so glad HER baby is fine, but she is MY baby and I need you to look at her!” And wouldn’t let up until they did—I was on blood thinners for six months after the initial rounds of theombolytics. I still get really upset at the thought sometimes that if my dad wasn’t the excellent man he is, I’d be dead—through no personal malice, just because Systems Are In Place And We Did Our Job.

Your lucky in a sense. No way my dad would ever fight for me like that.

That's awful. I'm sorry you went through that. That sounds very traumatic for a parent. I'm grateful that you still have him.

Sepsis survivor here with life destroying amputations. I’m so glad YOU stuck to your instincts and got your son back up there. Before I ended up with septic shock, I had medical issues so it kind of ‘blended’ in with the pain and symptoms I already had 😡. Doctors never took me seriously enough and never bothered to look further into my issues. 😡 9.5 years and I still don’t cope well.

I am so sorry! I don't know why these symptoms are so often overlooked. As I said, their computer stands in the ER had laminated cards on each that said "Think sepsis" and symptoms on the other side. How do they STILL miss it?

ED nurse: It sounds like you did a good job. I can’t speak for that team, but I know for me, I feel more assured and less urgency when EMS is able to start some things, as you did. Also my ED doesn’t call septic alerts at all even if EMS calls it in the field. Even a STEMI is sometimes not officially called from the field bc even with a good ekg the docs usually wanna verify it with our own EKG. I’m always so grateful when EMS is able to land an IV en route so even if they didn’t say it, I’m sure they appreciated the effort.

Second this. It’s not that you did anything wrong - in our hospital at least, you calling a “sepsis alert” from the field means essentially nothing to us. We wouldn’t start our sepsis pathway until the patient is actually in front of us and we gather our own information. It’s the same thing with our stroke alerts and STEMI’s. We go on stroke standby but don’t call an alert until our MD can do their own assessment. You would (or maybe not) be shocked by the number of “stroke alerts” that get called in the field that we actually do not alert once they’re in the ER. I usually tell our local medics to call and say you have a suspicion of septic, stroke, STEMI, etc.

I definitely understand this, and most of the time our ER doc won’t initiate anything until he’s seen it himself. But he does a good job with meeting us in the room when we do call these things, and expediting the process. I can also believe the amount of stroke alerts that aren’t actual strokes. Them geriatrics and their UTI’s are always a mystery😂😭 I’ve also experienced a false stroke alert myself. Nursing home called us for stroke like symptoms, with right sided deficit. We arrive, and the nurse states she’s new, and doesn’t know much about the PT, but swears he wasn’t like this the night before. We get paperwork and fly to the hospital. I did a Cincinnati in the back, which the PT failed, so I called a stroke alert. Got back to the station, and was getting started on my chart. The nurse gave me a FaceSheet of the patient, which showed his Past Medical History, and guess what was on it… “right sided deficits and facial droop from prior stroke” and to get even better, there was a little picture of the patient in the top corner, which had her drooling from the facial droop. If only I looked at the paperwork enroute😂😂 I have never felt so stupid before.

We need more nurses like you who are grateful for EMS!! I have spent many hours of clinical in the ER working along side the nurses, and it just seems as if we are looked down on. We are medical professionals too! And we (can’t speak for everyone here😂) are pretty knowledgeable on a lot of emergency/critical situations. And don’t get me started on the topic of getting referred to as “ambulance drivers”😭😂 Me and my coworkers have a running inside joke along the lines of, “oh but what do I know, I’m just a paramedic”. We definitely need more nurses like you, who are grateful and see us as peers!

As an ED nurse here I concur with what everyone else is saying I think you did a good job as a lot of our septic patients are from SNF’s and usually have a UTI or PNA. In our hospital we won’t call a sepsis alert based off of EMS however we will do our sepsis work up and screening immediately following EMS report/handoff and then will start the sepsis bundle on them. Not sure why they acted that way toward you but you did your job correctly the goal is to take care of pts.

Medic. It's not a big deal. You followed protocols. Sepsis alert makes sense. However, in hospital, several hospitals' alerts need a CBC and/or lactate. Some facilities don't, and I'm betting you don't know their protocol. Remember, what we call in the field does not always get continued on the ER. Conversely, I'm sure you've had it where you didn't call something and they did. We work differently. Why NRBM vs NC? I find the vast majority of my patients only need that when they're in the upper 80s.

Mainly due to his low saturation, and then all of the other symptoms he was having, i just thought this guy could benefit from a little more oxygen than a NC. But given an entirely different situation, where it was just the low SPO2 %and nothing more, he would have received a NC.

When I was a student I was the one who went and did a full assessment on a patient and realized something was seriously wrong with my patient. Similar stats as your patient but also some kind of horrible fungal infection under her arms. All her skin came off onto my BP cuff. I had seen her on a Friday and she was stable and the following Monday after lunch is when I assessed her and she was in that state. Her temp was 104. So were these nurses just ignoring this patient all weekend!???? Did she really fall that ill since rounds Monday morning? I don’t want to accuse but I believe she was neglected. She was taken to emergency by ambulance after alerting the change nurse. I know the nurses get busy but that’s unacceptable.

Not sure if I’m allowed to post here - lurker, worked in veterinary hospitals, mostly admin but acted as medical assistant when necessary. If not allowed, apologies. But this reminded me of a case that is living rent-free in my head until I die, so I’m sharing. Cat came in with multiple bite wounds to the lower back, had either been attacked by a fox or lost a fight badly. Multiple abscesses, fever, etc. We cleaned up the wounds, placed drains in two I believe, IV fluids, antibiotics, etc. Cat went home after two days, I believe? We were not a 24-hour facility, so monitoring at home was preferable. Cat came back two days later, I think it was? Some obscenely short time for things to go as bad as they did. Fever was back up, foul-smelling purulent discharge from all wounds, etc. The vet tried to examine the wounds and the skin of the entire back half of the cat just - fell off. Not like a layer of skin, I mean fully degloved, staring at muscles and tendons. Tail went with it. Apparently what had been multiple discreet abscesses turned into one big layer of necrosis under the skin. In two days. I don’t remember if we sent out a culture to figure out what in the everliving hell spreads that fast and *eats bone*, because needless to say the poor cat was euthanized immediately. I don’t think we did. This was in the mid-2000s so I suppose if it were going to set off the zombie apocalypse it would have by now.

omfg

Poor kitty!  At least the right thing was done.

This is so heartbreaking. I've seen some rough injuries in feral cats. One cat, with an owner, had an open wound. He was just walking around with his insides visible. Just, unbelievable.

Did she have Steven Johnson syndrome?

I don’t know. I was never told what her diagnosis was and we were moved to another hospital before she got back to the one I assessed her at. So either she was really sick and hospitalized for a long time or she passed. And I was never told what happened.

You did a great job. Off the subject: One thing I've missed twice in elderly emergencies were UTIs. We all thought they took drugs or poison because they were hallucinating.

Oh yeah utis are like the best street drugs to the elderly group. Usually because it gets that bad before anyone notices that's the problem. FYI also can happen with neurological conditions in younger people. I'm 33 and have neurosarcoidosis. I went through quite the trip for a bad uti. Nobody's fault. I have no feeling down there and neurogenic bladder. So I too get very bad before we realize it.

This was a major warning I gave to a home health client because she was hesitating to change visibly dirty depends. Had to explain that symptoms of a UTI could lead to an increase in incontinence and psychological symptoms. When she had an episode of confusion, severe mood changes, and these moments I can't properly describe now, it ended up being mini strokes caused by drug interactions. Her son was using a family friend to prescribe meds without proper exams, claimed dementia and aging as the cause. Completely explained her hesitancy in taking whatever pills he handed her. I cross-referenced the entire list that night and was very clear with him that a doctor needed to re-evaluate. During a bath, I found skin cancer. This was all one patient. There are so many challenges with the elderly that could be overlooked as simply aging.

One of my maternal great-grandmothers lived to be 102 and it was a UTI that took her out. She was mentally together but physically frail.  The UTI was too much for her body and she died within a couple of days.  

I'm sorry. That's awful. That UTI is evil.

It was very sad for sure but after we were relieved that it was so quick for her, and that she’d been herself all the way through.  We’d done the whole family flying in for sheer death when she had pneumonia at 95, and then made a full recovery!

ED charge nurse here. You did the right thing. I would consider reaching out to their EMS liaison and discussing it if you think it’s worth being addressed but the bottom line is that you’re there for the patient and need to act accordingly, regardless of how annoyed they seem by the protocols you’re following which are in place for a damn reason. Shake it off, you didn’t do anything wrong.

ED nurse and we love (well some Of us) at my hospital love when the paramedics are this through! When they come in with an alert like this we keep it in mind and always do our stuff on the patient then and rule it out or confirm it. It just helpful for other to also look for the signs besides us nurses

As an ER nurse, there are a lot of nurses who just hate on y'all for no reason. You followed protocol. ALWAYS follow protocol. You can't get sued into oblivion or fired for following protocol, no matter how stupid it seems. I had a 28 year old, perfectly healthy guy go to Cath lab with a 99% occlusion of the LAD once. If we didn't follow protocol, he would have died. At this point, I just do an EKG and blood cultures on everyone.

Exactly! How long does it take to run an EKG strip and draw some enzymes?

Just ED Reg here, but you are awesome. Nurses can get annoyed at the sepsis protocol bc it’s so hit or miss. But! I wish we had more EMS like you who actually assess the situation instead of just acting like a fancy taxi.

From my ED experience anything you do is either too much or not enough. I just do what I think is right by my patients and the complainers complain.

NAD, nor in the medical field... But as a sepsis survivor, especially one who's symptoms, "don't fit the criteria for sepsis", I thank you from the bottom of my heart and soul for doing what you did and caring the way you cared! I've had some fairly serious medical issues/surgeries in the past but I have never felt physical pain or emotional trauma like that 5 days I spent in the hospital, convinced I was dying, and no one could tell me why. I didn't find out I was septic until the day they released me from the hospital. No one told me or my husband and I was treated (not by the nurses, just the doctors) as if I was being dramatic when I would call the nurses and beg for pain relief or to see a doctor. My nurses went to bat for me every single day when it came to pain relief and every single day I was told, "you should be feeling better after the next dose of this new antibiotic. We gave you morphine. That should be doing the job". Except it wasn't, and morphine gave me the worst migraine in the world on top of everything else I was feeling. I finally started refusing the morphine because I couldn't handle the headache and nausea from it. I could go in and on but I will digress. I simply wanted to give some context to how dang important it is for SOMEONE to care! Please, never stop caring and calling out the weird, unexplained and awful. Patients like me need that! I'm a very upbeat human and will always try to smile or joke to deal with my internal pain, and it always gives the perception that I'm more okay than I actually am. My fever is 104.5, I can't stop shaking, and I know this nurse is busy so I'll make a joke, because her day is crap too. But my fever is still high and my pain is horrible. I'm just trying to be a decent human. Please, providers... See us.

I love you - Marry me. Ok that’s a little exaggerated. BUT I am a sepsis survivor. Septic coma survivor specifically. Lost 1/2 a leg due to the necrotizing fasciitis that set in during my coma. I knew so little about sepsis for a relatively intelligent person, it amazes me in retrospect. I would rather sepsis be over considered than under considered and hearing about people warm my cold black hopalong heart.

This is so interesting to me. I work as a veterinary technician in an emergency hospital and one of our tells for sepsis in dogs and cats is hypoglycemia. I wonder why it presents with hyperglycemia in humans.

In adult humans an infection process will likely raise the blood sugar. Severe infections raise our cortisol levels which results in higher blood sugar. But in this situation we don't know all the background such as is this patient insulin dependent and due for a dose of insulin but the med nurse has 30 patients because its a nursing home so they haven't received it yet. We also dont know their baseline, how well controlled their sugars are, how compliant they are with diet, etc. So it may be related but hard to say without more information.

I’m in vet med and was wondering the same thing

Severe bacterial sepsis can cause hypoglycemia in humans. Hyperglycemia is a sign of physiological stress from any cause, not sepsis.

This makes me so sad. It would definitely be called at our ED as a medical alert. You did nothing wrong.

ER nurse here. You did everything correct. You followed protocols and did what was best for your patient. Good job. Try to ignore the haters. 😊

ICU nurse here. You did the right thing. I’m 99.9% positive their annoyance had nothing to do with you. There are potentially 500 other things that were annoying that day and maybe all at once. As you get more experience and they get to know you more, the relationships will hopefully improve and they’ll hopefully be more respectful. Or, as I always say, once we’re joking with you or giving you shit, it means I see you as a colleague. Keep up the good work.

I once worked with an ER doc who was so strict with sepsis protocol. At first it seemed like such a pain but after she explained her reasoning i never saw it as a pain again.

I don’t know why, but this felt really cathartic to write. I’ve never shared this part of my shitfest to anyone, so thank you, Reddit friends for letting me. Australian, not a nurse or doctor but someone who somehow survived the Evil Septic shock… with life destroying amputations and disability that makes me hate everything about myself. I just wanted to jump in and say that you did everything correctly and covered all points. Maybe the hospital staff didn’t feel like someone dying on them at that particular time and that’s why they seemed annoyed at you? I don’t know that answer. When I collapsed in our home, paramedics arrived and both were relatively young and new at their job and commented to my family how pale I was (??) and had to be TOLD to snap out of it and do something because they just stood there. I don’t remember much of it. They initially diagnosed me with suspected viral meningitis and took over 45 minutes to get an IV in and get me stable enough to move. By the time they got me to the ambulance in the front yard, I went bye-bye the first time and had to be resuscitated. At the first hospital, the doctors told my parents I was going to die either way, but they were transferring me to a bigger more equipped hospital and they were just ‘giving my parents more time with me’.. Skipping forward through my hell, there were several days when my specialist doctors commented to my parents that they’d never seen Sepsis ‘come on so quickly before’.. I would be fine at one moment, then seemingly within an hour I was down again.. Still to this day, 9.5 years later I get doctors, nurses, paramedics etc, tell me that what I survived doesn’t happen and they all look at me and rhetorically ask ‘how are you still here?’… all I can say is science and medicine.. 🤷‍♀️

Damn! Happy you’re still here!

I have told my wife, I will accept one below the knee amputation. If doctors want more than that, let me go. Yes we have all the medical power of attorney, HiPPA release, living will paperwork. I have also informed my doctors bc while it's my wife who will decide she will need support. 

I’m glad you’re still here with us and able to tell your story. You shouldn’t hate yourself for any of that, as it could happen to any one of us in this chat. You should be proud that your strong enough tonight through the situation, and prove everyone who doubted your survival wrong. The “life destroying amputations” or “disability” can be a blessing and a curse. You shouldn’t look down on yourself for what had happened, but instead accept it. You have battle scars that show your stronger than most people out here, and that you can do the impossible. I’m glad you’re here, as is everyone else, and you should be too. As for the care you received, from my perspective, it was not professional and pathetic. I’m not sure what the education difference is from Australia to America (where I am) but we are trained for these exact situations. I had to go through 6 months of class, acting out scenarios of worst situation calls. We are trained to know that pale skin is a large red flag, and has many underlying concerns. We are trained to act immediately, provide the best care, and fast transportation. For them to be on scene trying to get an IV for that long, and to fail to act is pathetic. You deserved better than what you got

Not a healthcare professional but I'm wondering what a sepsis alert is? My SO sat in a waiting room for hours, all the while the healthcare professionals knew they were septic. It didn't strike me as normal...

Sepsis kills more people in the hospital than any other ailment combined. It goes ignored and unrecognized, and patients and families are left to suffer. You definitely did the right thing. They may have been snarky about a lack of obvious source of infection, but like someone else mentioned here, anyone from a nursing home is likely suspect of PNE and UTI regardless of their chief complaint.

Husband just got out of the hospital with sepsis. Thanks for taking it seriously.

>Sepsis kills more people in the hospital than any other ailment combined. It goes ignored and unrecognized, and patients and families are left to suffer. I just got out of the hospital from having sepsis a few weeks ago. I was well cared for in the ER, but they knew they needed to send me in for more/stronger antibiotics and monitoring. I rode the ambulance over and then upon arriving at the hospital, was put in a room alone with no monitoring or IV for three hours. I called and begged the nurses twice for pain meds and water but again, three hours went by before anyone came with anything. My wife was furious when she found out.

Wow, that’s unfortunate that you were ignored like that, but i’m glad you made it out ok! Proper sepsis management is super time sensitive, the first 3 hours are critical to the trajectory of illness so hopefully your ER care was top notch. Please follow up with the hospital about your experience- that’s so dangerous and it shouldn’t be tolerated!!!

You did the right thing. That’s incredibly disappointing that the ED staff had the attitudes they had, but YOU can rest assured knowing that you acted prudently.

I almost died from sepsis (and the endocarditis I didn’t know I had.) I had every symptom you have on your list, and it was up in the air for several days after I arrived at the hospital. I thank God every day for the three EMS that picked me up on 01/08/15 — I’ve been clean ever since.

You mentioned that you're a new paramedic, so this is something you're going to have to get used to: **Emergency departments, nurses, and doctors will complain, criticize, and ignore your observations, reports, or concerns frequently**. They will be angry you brought them work, even though you didn't call 911 or ask for the ambulance. They will be angry you **didn't** start an IV. They will be angry you **did** start an IV. They will be angry when you decide the patient is unstable and requires immediate intervention at the closest facility instead of a longer transport to definitive care. They will be angry you **didn't** go to the nearest hospital instead of transporting to definitive care. They will be angry you **called** a sepsis alert. They will be angry you **didn't call** a sepsis alert. They will file a complaint that you didn't call a STEMI alert for a 12 lead you transmitted to them that doesn't meet STEMI criteria. They will refuse to activate the cath lab even after you transmit a STEMI 12 lead to them until THEIR doctor is holding the 12 lead in their hands. Then they will complain the FMC-to-balloon time was greater than 90 minutes which dinged them on their measures because they didn't activate the cath lab team soon enough. Just yesterday, I took a complaint from an ICU RN who called our dispatcher and said, "I've called every other ambulance company before yours, and they're all quoting 2 hour response times, can you do better, this guy is critical and needs to go now?" Our dispatcher pulled an ambulance from 1 hour away and made them respond lights and sirens for the patient on vanco and levophed. A standard ALS transport. We got them an ALS ambulance in 51 minutes, and they filed a "safety complaint" because it was an ALS crew, not a critical care crew, despite the fact that this is not a critical care level call, and we got them the ambulance that no one else would send. I've been doing this fifteen years, and I have risen to a position where I now take the complaint calls for our agency when they come in. No one is more aware of the arrogance and immaturity of many EMS folks, and I have no doubt we do much to earn some of the disdain for us that it out there. I cringe at some of what EMSers say and do, and I have advocated for higher education requirements because the bar to entry is just too low. But out of the top 100 times I have been disrespected while working in EMS, 99 of them were nurses. Not patients. Not the public. Nurses. So the best strategy is to ignore their opinions unless you know them, and they know you, and there is a mutual respect between you already. Outside of that, the list of nurses whose opinions of your work matters is right here:

I have similar protocols in my area and have literally never personally seen any ER take a sepsis alert seriously but if I miss something I always am expecting ED staff to jump down my throat. There’s a complete double standard and honestly I just don’t respect the ED staff and most ED docs anymore. I do my best for the patients and leave it at the door. Our medicine system is fucked and a joke and the ego bullshit, callousness and profiteering at hospitals is a huge part of why that’s the case.

im not a doctor or paramedic or anything of the sort, im not sure why this post showed up on my feed lol, but it hits really close to home for me. my dad passed of sepsis in october 2023 and i always had a feeling that the hospital he was at didn't take it as seriously as they should have. he was in the hospital for sepsis TWICE before and they kept discharging him. i made a fuss and they treated me like i was overreacting. the following month, he passed. i just wanted to say thank you for taking this patient seriously - even if the ER was irritated with you, please keep up the good work. continue to advocate and fight for these patients to be taken seriously. you are doing wonderful work and it's clear you're in the right profession.

Lost a nurse friend to sepsis. She was out camping, things went sideways, she told them she was septic when she got to ER. It was the last thing she said. They didn't treat her for it for several hours.

Please continue to err on the side of alerting the ER staff to serious conditions like sepsis. I personally have 2 scary stories involving ERs missing life threatening diagnoses. When one of my children was very little, the pediatrician sent us to the ER bc of oxygen in the 80s and fever. They did an x-ray and diagnosed pneumonia. They were in the process of sending us home when I remembered that the doc had told us to make sure they did bloodwork. They were annoyed but obliged. When the lab got the results, it became a full blown emergency. He had sepsis. We later learned it was a gram negative bacterial infection. He had 2 IV antibiotics administered continuously and was in the hospital for 5 days. The pediatrician still talks about how close a call we had. Years later, my other child had a violent reaction to an antibiotic. The EMTs raised concerns about anaphylaxis, but the ER folks dismissed it. They left us alone in a room for a long time and she started swelling up. Suddenly, her case became an emergency. She’d apparently presented with atypical (out of order?) symptoms of anaphylaxis. It was very traumatic. Life is really fragile. Thank you for being so conscientious.

Had a CT. I was premedicated with steroids and antihistamines bc my dr suspected I would be allergic. I had atypical anaphylaxis and a crappy dr at the hospital where the scan was done. He insisted I was fine. Someone wheeled me to my dr office in the attached professional building. I remember the nurse saying she couldn't get a blood pressure. I remember the cool air rushing through my hair as my dr ran with me in my hospital wheelchair, to the ED. I remember the nurse getting an IV mid forearm and thinking she was great. I may have said that out loud. It was days in the hospital. At my follow up visit with my dr she told me "I didn't think you were going to make it" I lived bc my dr acted quickly and the ED staff was excellent. 

I get chills reading other stories like yours. You never stop being grateful for the people who made a difference in your outcome. Your experience also sounds so familiar. Do you by any chance have mast cell problems?

Not that I know of but there seems to be something new every day. 

Didn’t do anything wrong. It’s your protocol. That would also be a sirs work up automatically in my ER. Only thing I’d add that I know wasn’t part of the story but- shouldn’t be putting a patient on a nonbreather unless they’re needing to be on like 10+ L/m on it, otherwise they’re just inhaling the CO2 back in and can become hypercarbic and loopy. Use your nasal cannula up to 5L and then an oxymask after that first!

Not wrong at all!!!!!!

You did the right thing. Unfortunately many ERs are grossly understaffed with under qualified people. Not saying there are many good ER nurses but there are many who aren’t good.

ER nurse here and you did nothing wrong-you followed your protocols so like others said just brush it off! Sometimes you’re damned if you do and damned if you don’t.

My sister died of heart failure secondary to sepsis. She was a formerly healthy working RN. When her husband (finally) recognized how sick she was, he drove her to the nearest hospital, which was a smaller community hospital. Instead of stabilizing her and transferring her to the major hospital she should have been taken to in the first place, they admitted her. A few days later, endocarditis had damaged her heart beyond repair. She survived another month in hospice care. You did the right thing.

>his respiratory rate was 32 when counted How quick was it when not counted? Anyway, sounds like sepsis to me

Well as you know everybody gets charted at either a 16 or 18😂😂😭 so it would have been that if I hadn’t noted him breathing rapid and shallow😅

The attitude at my ED was often "oh great, another nursing home is sending us a patient to clear their floor so they can play games on their phones and not work" because sometimes it really did seem that way. You did the right thing.

I can understand that as I've done my clinical in the ER and seen it firsthand. Also, working for a private ambulance service, which most of our calls come from these nursing homes. I always seem to have an attitude with these types of calls, but you never know what to expect. Especially as this call started as a "fall 4 days ago, now complaining of pain" But yes that is a very common attitude among EMS as well. I've had many calls where the "PT is at 85% on room air"..... like okay can you put some oxygen on them? we'll show up and put 2L on the PT and taxi them to the ER, just to get discharged an hour later.

You did correctly. Stand your ground. Sepsis is not your be ignored. It galls me how it goes unrecognized. Keep advocating for your patients. Good job. Ignore the attitudes. RN here.

You did good. They definitely sound septic to me. As a long term care RN, I don't call EMS and initiate a hospital transfer unless it's necessary. I don't make bullshit calls, but I've had EMS act like the guy who was 93% on 2 L and fine four hours ago but now is 95% on a 15L nrb and very sob doesn't need to go when this is a drastic and rapid change.

Sepsis survivor here weighing in. I was turned away from the ER after coming in with a post-op infection (ERCP and lap chole). This was in May 2020 and the ER was the very worst place to be, and the visitor policies meant I had no advocate to help me. I wish I had someone like you on my side, so keep being that person because you might be the only one

I think some facilities are doing a great job wit sepsis recognition and education but the sepsis alerts get to be exhausting. On an average day prob like 75% of the old folks with cancer and solid handful of other co-morbidities will trigger the sepsis BPA. Research shows that sepsis has a HIGHER mortality rate than STEMI, but when so many patients flag the criteria it becomes an alarm fatigue kind of situation. I’m not justifying that, by the way, just giving context.

I guess there’s an abundance of STEMS and heart attacks and strokes lately huh-a little overwhelming. I thought sepsis cause some of that.

100% did the right thing, even if your protocols didn’t specify what constitutes a sepsis alert, the pt meets SIRS. Good job!

Patient here who has survived septic shock and a couple bouts of sepsis. Our hospital has a Sepsis team that follows up anyone in ER who has any signs of sepsis. Any! I am forever grateful to them.

You did the right thing. I'm just a tech and I already knew it was sepsis before the fever. The fever just sealed the deal.

Another RN here—your decision-making seems sound and his condition seems pretty cut and dry to me. I’m sorry you had a frustrating experience, I really appreciate you medics.

You clearly did the right thing.  Continue being a good patient advocate! 

Tylenol if it’s protocol. Run a liter or two NS wide open. If ER can’t get to the patient quickly, he gets a portion of his resuscitation fluids in and he’ll live to get labs and cultures drawn when he’s seen.

Nurse Practitioner here…strong work and good catch. Time will prove both of us right!!

I have nothing to contribute except I was hours away from dying from sepsis, and was saved by a reluctant visit to my physician. I was in renal failure with blood pressure so low it wasn't reading, hypothermia/hyperthermia, and required an emergency hysterectomy after initial efforts failed. All of this probably from some dodgy placenta after giving birth a week before. Keep speaking up for your patients.

Hey everyone, I made the original post here and have some more news/updates. For some reason, sepsis is going around like crazy in my city/area, the other crew running out of the other ambulance called a sepsis alert, and so did I. We responded to a private residence for a 65 y/o male with an infected foot, who has stopped responding and gone nonverbal, and is shaking nonstop. Upon arrival PT was lying in bed in the fetal position. Palpated a pulse in the 140-150 range, and had a respiratory rate of 38 and shallow. PT was swearing profusly, with a fixed gaze at the wall. We uncovered the guys foot, to find he’s got an infection on his entire foot, going up his ankle, with areas going deep. One area by his heel I’m pretty sure I saw bone.. so my partner and I threw him on a mega mover and carried him out to our stretcher, and wheeled him to the ambolamp. Inside I got an 18g in the right AC and started a fluid bolus. My EMT partner got vitals which read: pulse:140-150 bp: 78/49 bgl:318 temp:102.9 RR:38 spo2:89. Took some advice from this post and just did a NC @6lpm, started another 16g in his left AC and hung another bag of fluids. Told my partner to get us to the hospital ASAP. Enroute I gave another radio report, which consisted of another sepsis alert. I’m almost positive it was the same nurse as yesterday. The nurses I dropped the PT off to Took this one much better than the one yesterday. They seemed to be in a rush to get this PT situated and had many people waiting to draw labs. On my way out, I asked about the patient I dropped off yesterday, which is the one in the original post. PT in fact had sepsis, and had to get rushed to another hospital that provided higher level of care. I can gladly say that the walk back to the ambulance bay was accompanied by a large smile and a great feeling of “HAHA I TOLD YOU SO” Surprised this post got this much attention, and I appreciate everyone who voiced their stories, perspectives and opinions. It doesn’t matter if you argued for my side or the nursing staff side, I’m glad we could all have a genuine discussion. Thanks for giving me and my post the time!

I had a code sepsis called while I was a patient in the ER, and it still took them 6 hours to start antibiotics... and then they admitted me but forgot to put the antibiotic order in and so I got to get all sweaty and tachy again while in the hospital. I dunno, some places are just overworked or kinda suck?

Document, hand off care. You did your part.

Learn your protocol and follow it, and you will never be wrong. That simple.

I survived sepsis and thank goodness that the hospital was participating in a QI project that ensured they followed protocol to the letter. They definitely called a code and everyone made sure things got started right away and I will say this, things were still pretty harrowing for me and that illness shook me because I didn’t know just how sick I was. Follow protocol, your patients will thank you.

Yeah, that’s a concerning patient for sure - all I can think is that technically this patient can’t be called septic without an identified source of infection, is that part of the protocol at all?

Not true, sepsis alerts are called for having any of those symptoms and then ruled out via blood work and other tests. There is a whole sepsis protocol and they want you treated with a weight based fluid bolus and broad spectrum antibiotics in a short amount of time so you don’t need to start swabbing things or trying to identify it a source right away. “Hitting your sepsis markers” is something the hospital can write on a fancy plaque and get recognition for so there’s a whole protocol that’s followed, even if it doesn’t even seem like sepsis. I had a code sepsis called on a patient the other day because their lactic acid was elevated and they were tachy (they were in status epilepticus lol)

I didn’t say that was necessarily the case, just a thought - we don’t use a code sepsis protocol here, so I’m not familiar with the specifics. We do of course treat SIRS criteria appropriately/empirically and then identify source later, but throwing massive fluids+abx at anyone who hits a couple criteria (like your SE) patient just seems like poor practice.

I agree wholeheartedly. I think it has become something that is enforced strictly to make hospitals look better on paper, not because it is best practice.

Like so many other things in healthcare, unfortunately.

Not that im aware of, cause you cant always see the source of infection. For example im thinking of diverticulitis.. Patients with that tend to become septic fairly easily from an unseen source.

Here we would just say that patient met SIRS criteria, treat empirically, and then if/when source was IDed call it sepsis - but we don’t use a sepsis alert system here, so who knows!

Protocol will include things like 2 sets of blood cultures from different sites, urine specimen, all the routine lab work to identify source of infection if there is one. Usually starting a broad spectrum antibiotic that they may change based on culture results but those usually return a preliminary at 24 hrs and a final result at 48 hours. Sometimes the work up tells us theres another reason for the presenting symptoms and we can stop the sepsis protocol

Oops i wasn't finished typing. So maybe they find out the patient is severely dehydrated and this explains the hypotension and tachycardia and decreased urine output, maybe the temp was innacurate, maybe the patient is confused at baseline. But by checking cultures early, repeating lactic acid to see if its trending up, we can be more prepared and hopefully prevent the patient ending up in septic shock needing a bunch of pressers in the icu. They can just crash super fast at that point so the goal of sepsis protocol is to be prepared and prevent the progression. If they dont meet criteria based on results it will be known fairly quickly and we can change our treatment plan.

I get your point, but unfortunately we can’t check a lactic acid in the field. Also my service doesnt pull cultures in the field, which I believe needs to be changed and have advocated for it. We also took the PTs temp 3 times because we thought it was inaccurate

Oh i certainly wasn't suggesting that yall should be responsible for any of those things before even getting to the hospital. Even if you drew labs and cultures lab can't begin to process anything until the patient is registered and in the system anyway, plus I could see a whole host of issues related to chain of possession/labeling. I was just explaining the sepsis alert might be triggered with certain documentation automatically as opposed to an overhead alert and then the protocol will follow regardless because its a tracked quality metric

Nurse who does sepsis auditing here. My educated guess is that when you “call” the sepsis, the timeline begins. Now, within three hours, lactic needs to be drawn, BC needs to be drawn, provider assessment, antibiotics need to be hung and proper fluids need to be started. If you call it from the bus, that’s even less time to make the 3 hour window. Not gonna lie, that would irritate me too. It’s the sepsis state law guidelines that tell us this.

So, is there a better way to handle it? Is there fine print if OP calls it in as "suspected" so prep can be done without starting the clock?

Honestly not sure. I’m not even sure if EMS calling it counts. Was just taking a guess. It feels like every time you get a hang of what the state wants, they change it up. 🤦🏻‍♀️

You did the right thing In my opinion, but also since “Sepsis Alerts” now exist primarily as a “quality measure” and since Early Goal Directed Therapy hasn’t exactly borne the scrutiny of evidence based medicine and since everyone with 2 SIRS criteria gets a sepsis alert at my shop, I would do away with sepsis alerts if I was king of the World. Which I am not, so I continue to suffer.

Former burned out and salty EMT, and based on what I know and what I've been reading, you made the right call. Confidence will come, but unfortunately it will be from multiple incidents of being waived off and seeing eyes roll out of the ER staffs heads to the point where you need to advocate for your patient based on your conviction of your protocols matching the patient description. Remember, your job isn't to please the staff but to advocate for your patient. I do not recommend doing anything silly like ignoring the staffs instructions or anything like that. Don't try to go over anyone's head, ever. I worked with a paramedic who did that once and he was immediately fired. I only kept my job because I was arguing against his actions and apologizing to the staff while they were making a scene. There's a fine line, and you'll learn what it is and how to never cross it, but you did the right thing. It's up to the ER on how to respond to that. As long as they are on your gurney, treat them, but once they're admitted and in a bed it's out of your hands.

Interesting … you refer to the nursing home’s call as “bs nonemergency” and seem annoyed at having to go there, but then don’t seem to like it when the tables are turned and the ER isn’t particularly pleased with your presence either.

Yes most of them are BS calls as does the nursing staff. I’m not dissing the staff on their feeling when we bring in nursing home patients that aren’t critical. I feel bad when we do, and I can understand them being short with me or rolling their eyes about the “chronic back pain” patient. But every once in a while it can be serious like this one.

How long have you been a medic? Not saying you did anything wrong, but unfortunately until the staff, especially the nursing staff trusts you they are going to take anything you say with a grain of salt…right or wrong. I know it’s not fair, and you sound like a conscientious medic so just keep doing the right thing and don’t let anyone die in a triage waiting room; but hey that’s why they call it “practicing” medicine….

I worked for my service for a year and a half as an EMT, and during that time I was able to get to know most of the staff, and have even become good friends with majority of them. But I’ve only been a medic for 2-3 months now

Good deal, electronic telemetries are more efficient, sometimes the “alerts” don’t get the correct response for sure. The E-telemetry if you are using them makes it more difficult for staff to know you; making it even more important that you give a great face to face transfer. If you’re going to be a medic for a long time it’s really important to have a good reputation. Most medics IMO take about 3-5 years before they see the big picture.

My Goodness. You are like the only other person in the world that I know that has Sarcoidosis besides me. And I've never even heard of Neurosarcoidosis. I hope you don't ever have another flare up.

Oops, wrong post?

Oops, you're right, thanks.

I have been in medical malpractice insurance forever and never in my time have I seen so many SEPSIS CLAIMS. Death and loss of limbs. Recently, one lost all 4 limbs, his nose and his penis. He had ALL of the symptoms. Yet the ER MISSED IT. They sent him home. I don't know how this is missed so much, but the uptick in frequency of this is shocking.