Red Flag Sepsis Pre-hospital Treatment and Fluid Bolus

Q. Our current local trust and the current Sepsis Trust guidelines advocate the administration of a 250ml sodium chloride fluid bolus even in the normotensive patient. However, current JRCALC guidelines recommend only giving fluid therapy to red flag sepsis patients with a systolic blood pressure of 90mmHg or less. Why does JRCALC not advise that we give a fluid bolus in the normotensive patient? Where do we stand with this difference as paramedics?

A. JRCALC is aware of the guidance by the Sepsis Trust. The Sepsis Trust gives guidance on how to treat patients with established sepsis but does not take into account the differential diagnoses of the patients presenting to the ambulance service.The JRCALC guidance is very clear that sepsis is a hospital diagnosis and the guideline is for suspected sepsis with rapid transport to hospital and required treatment given en-route. Most patients with a NEWS2 score of 5 or more are unwell and some will deteriorate if given too much fluid before their diagnosis is made. So, we consider that our current JRCALC guidance on fluid for sepsis marks a balance with the patients most at need of fluid getting it. We would recommend that for each patient a clinical judgment is made regarding fluids, and taking into account other factors such as time to definitive care. It is for each service to decide whether it varies from the JRCALC guidelines. When a service has chosen to deviate from JRCALC, we advise that clinicians follow their own local service guidance.