Reducing Severe Sepsis Mortality via an Interfacility Severe Sepsis Treatment Protocol

mal data were executed with Kruskal-Wallis testing, and linear regression was used to adjust for potential confounders of the identified relationship between frequency of transport runs (i.e. number of occurrences of a given run during the study period) and dispersion of flight times for given runs. Analysis was conducted with STATA 13MP, and significance was defined at the p⬍0.05 level. Results: For the overall n of 1000 transports and 159 distinct runs, the breadth of flight times for individual runs had a median of 8 minutes. The run-specific dispersion measure of flight time range divided by median flight time had a median of 0.23. For frequent runs (occurring ⬎6 times), the median range of flight times was 39 minutes with a 7.7-minute 95% CI around that median. Regression analysis demonstrated that the dispersion of flight time ranges around the median was 17% greater (95% CI, 13%-21%, p⬍0.001) for more-frequent transport pairings, as compared to those transport pairings occurring fewer than 6 times. Conclusion: The study results suggest that, for one-way transport runs conducted by the same helicopter, flight times are quite consistent for individual transport run pairings. This consistency means that historical flight times even for lesscommonly performed transports provide a reliable instrument for predicting future flight times for the same run. ■ Prehospital Use of Hemostatic Bandages/Tourniquets; Translation From Military Experience to Implementation in Civilian Trauma Care Scott Zietlow, David Morris, Kathleen Berns, Donald Jenkins, Mayo Clinic Medical Transport John Zietlow, Creighton

Introduction: While the military use of tourniquets and hemostatic bandages is well established, there is a paucity of data regarding civilian emergency medical services (EMS) systems experience. Methods: Retrospective review of consecutive patients with prehospital tourniquet (6/20/09-1/1/14) and hemostatic bandage (11/4/11-1/1/14) application in a single service ground and rotor wing rural program. Results: Of the 125 patients identified, there were 77 tourniquets (CAT) in 73 patients and 62 hemostatic bandages (Quik Clot Combat Gauze) in 52 patients with a maximum of two for any patient. Seven patients required both interventions. Mechanism of injury for tourniquet use was 50% blunt, 43% penetrating, and 7% uncontrolled hemodialysis fistula bleeding. Tourniquet placement was equitably distributed between upper and lower extremities as well as proximal and distal locations. Mean tourniquet time was 27 minutes with 98.7% success. Mechanism of injury for hemostatic bandage use was 50% blunt, 35% penetrating, and 15% other. Hemostatic bandage application was to the head and neck (50%), extremities (36%) and torso (14%) with a 95% success rate. There was one death in the field unrelated to tourniquet use.Training for both interventions was hands-on and computer based with maintained proficiency of ⬎ 95% after two years. September-October 2014

Conclusion: Application of tourniquets and hemostatic bandages in prehospital civilian care are highly effective with proficiency of skills maintained despite infrequent use. ■ Reducing Severe Sepsis Mortality via an Interfacility Severe Sepsis Treatment Protocol Kevin Collopy, AirLink/VitaLink

Introduction: Severe Sepsis is a life-threatening emergency when a known infection presents with evidence of Systemic Inflammatory Response Syndrome (SIRS) plus hypotension or an elevated lactate. Throughout the United States, the Severe Sepsis in-hospital incidence is around 13% with mortality ranging from 14.7%-29.9%. At New Hanover Regional Medical Center (NHRMC), the Fiscal Year 2011 severe sepsis mortality was 15%; yet for the subset of patients interfacility transported to NHRMC with a diagnosis of severe sepsis (n⫽84) mortality was 47%. Referred patients frequently did not receive the complete Society of Critical Care Medicine (SCCM) severe sepsis 3-hour treatment bundle. Methods: All Critical Care Transport Team staff were trained on SEPSIS recognition and management. A Severe Sepsis protocol implemented on 1 June 2012 which includes all of aspects of the SCCM 3-hour severe sepsis treatment bundle. Patients were treated for with the severe sepsis protocol when they had a known infection, a SIRS response plus either hypotension following 1 Liter of normal saline (NS) or an elevated lactate. Moderate complex point of care lab testing (POCT) allowed transport team members to determine serum lactate. Patients requiring interfacility transport to NHRMC were monitored from 1 October 2012 through 30 September 2013 and all patients meeting severe sepsis diagnosis criteria at the time of transport were included in analysis. Transport team compliance with the Severe Sepsis treatment bundle and patient in-hospital mortality were monitored. A z-test was performed to determine if the mortality change was statistically significant. Results: 67 patients met severe sepsis diagnostic criteria and were included for analysis. Severe Sepsis or septic shock was listed in the discharge diagnoses in 91% of cases. Overall mortality was 24% which was a statistically significant change (pⱕ0.05). Provider treatment protocol compliance was monitored monthly and annually to ensure the 3-hour SCCM treatment bundle was met Conclusion: The implementation of a critical care transport severe sepsis protocol is effective in reducing severe sepsis mortality as it reduces delays to appropriate early goal directed therapy. Additionally, this program maintained a 91% specificity rate which suggests that critical care interfacility providers can accurately diagnose severe sepsis. ■ The Novel Use of a Mobile Simulator for Skills Development of the Rural Healthcare Practitioner Aristathemos Scott, Matthew Hogan, Shock Trauma Air Rescue Society (STARS)

Introduction: In March 2014 the Saskatchewan Shock Trauma Air Rescue Society (STARS) began operating a 209