Fluid therapy in patients with suspected infection is controversial, and it is not known whether fluid treatment administered in the prehospital setting is beneficial. In the absence of evidence-based guidelines for prehospital fluid therapy for patients with suspected infection, Emergency Medical Services (EMS) personnel are challenged on when and how to initiate such therapy. This study aimed to assess EMS personnel’s decision-making in prehospital fluid therapy, including triggers for initiating fluid and fluid volumes, as well as the need for education and evidence-based guidelines on prehospital fluid therapy in patients with suspected infection. An online survey concerning fluid administration in prehospital patients with suspected infection was distributed to all EMS personnel in the Central Denmark Region, including ambulance clinicians and prehospital critical care anaesthesiologists (PCCA). The survey consisted of sections concerning academic knowledge, statements about fluid administration, triggers to evaluate patient needs for intravenous fluid, and clinical scenarios. In total, 468/807 (58%) ambulance clinicians and 106/151 (70%) PCCA responded to the survey. Of the respondents, 73% (n = 341) of the ambulance clinicians and 100% (n = 106) of the PCCA felt confident about administering fluids to prehospital patients with infections. However, both groups primarily based their fluid-related decisions on “clinical intuition”. Ambulance clinicians named the most frequently faced challenges in fluid therapy as “Unsure whether the patient needs fluid” and “Unsure about the volume of fluid the patient needs”. The five most frequently used triggers for evaluating fluid needs were blood pressure, history taking, skin turgor, capillary refill time, and shock index, the last of which only applied to ambulance clinicians. In the scenarios, the majority administered 500 ml to a normotensive woman with suspected sepsis and 1000 ml to a woman with suspected sepsis-related hypotension. Moreover, 97% (n = 250) of the ambulance clinicians strongly agreed or agreed that they were interested in more education about fluid therapy in patients with suspected infection. The majority of ambulance clinicians and PCCA based their fluid administration on “clinical intuition”. They faced challenges deciding on fluid volumes and individual fluid needs. Thus, they were eager to learn more and requested research and evidence-based guidelines.

中文翻译：

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疑似感染患者的院前补液治疗：救护人员实践调查

疑似感染患者的液体治疗存在争议，目前尚不清楚在院前环境中进行液体治疗是否有益。在没有针对疑似感染患者的院前液体治疗的循证指南的情况下，紧急医疗服务 (EMS) 人员在何时以及如何开始此类治疗方面面临挑战。本研究旨在评估 EMS 人员在院前液体治疗中的决策，包括启动液体和液体量的触发因素，以及对疑似感染患者的院前液体治疗的教育和循证指南的需求。向丹麦中部地区的所有 EMS 人员分发了一项关于疑似感染院前患者补液的在线调查，包括救护车临床医生和院前重症监护麻醉师 (PCCA)。该调查包括关于学术知识、关于液体管理的陈述、评估患者对静脉输液需求的触发因素以及临床情景的部分。总共有 468/807 (58%) 名救护车临床医生和 106/151 (70%) 名 PCCA 对调查做出了回应。在受访者中，73% (n = 341) 的救护车临床医生和 100% (n = 106) 的 PCCA 对给院前感染患者输液充满信心。然而，这两个小组主要基于“临床直觉”做出与流体相关的决定。救护车临床医生将液体治疗中最常面临的挑战命名为“不确定患者是否需要液体”和“不确定患者需要多少液体”。评估液体需求的五个最常用的触发因素是血压、病史采集、皮肤膨胀、毛细血管再充盈时间和休克指数，最后一个仅适用于救护车临床医生。在这些情景中，大多数人给疑似脓毒症的血压正常女性服用 500 毫升，给疑似脓毒症相关低血压的女性服用 1000 毫升。此外，97% (n = 250) 的救护车临床医生强烈同意或同意他们有兴趣对疑似感染患者进行更多关于液体治疗的教育。大多数救护车临床医生和 PCCA 的液体管理基于“临床直觉”。他们面临着决定液体量和个人液体需求的挑战。因此，他们渴望了解更多信息，并要求研究和循证指南。