The World Health Assembly and the World Health Organization (WHO) today adopted a resolution to improve, prevent, diagnose and manage sepsis – “a quantum leap in the global fight against sepsis.”
Sepsis—a condition that arises when the body’s response to an infection injures its own tissues and organs—is the No. 1 killer of hospital patients, and more than 1 in 5 do not survive. At least 1.5 million sepsis cases occur in the U.S. annually.
Derek Angus, M.D., M.P.H., chair of the Department of Critical Care Medicine at the University of Pittsburgh and UPMC, has been deeply involved in global efforts to improve sepsis diagnosis and treatment. He served as chair of the International Sepsis Forum for the last two years. In that capacity, he was on the council of the Global Sepsis Alliance, which was the organization that proposed this recommendation to the WHO. Along with Christopher Seymour, M.D, M.Sc., assistant professor in Pitt’s departments of Critical Care Medicine and Emergency Medicine, Angus has several on-going research efforts helping to try to promote the best sepsis care not only in the U.S., but in less well-resourced, lower-income countries.
“As an organization interested in improving sepsis care—both for our patients at UPMC and for all patients through our research at Pitt—we can certainly generally applaud, endorse, welcome this resolution,” said Angus, also director of Pitt’s Clinical Research Investigation and Systems Modeling of Acute Illness Center.
Q: What is the significance of the WHO setting this global priority?
A: WHO has a very deliberative process to try to ensure that governments around the world can be asked to engage in a focused way on particularly pressing problems. That sepsis per se, and not specific infectious challenges, should be seen as reaching this threshold emphasizes the magnitude and importance of this global problem.
Q: Please explain the background that led to this decision.
A: Sepsis is incredibly common, a source of great mortality and morbidity, and yet potentially amenable to a number of corrective actions. None of these happen without raised awareness and attention. Furthermore, sepsis ravages all societies and all age groups. The agenda that ensues from this attention-raising has implications both of basic health care delivery systems, focusing on ‘doing simple things well,’ and for researchers in academia and industry, focusing on harnessing advances in biomedical science to improve diagnostics and implement better tailored precision therapies to support the immune system, combat highly resistant bacteria, advance the provision of effective, safe organ support for vital failing organs, etc.
Q: How is sepsis a different problem in third world countries, compared to the U.S.?
A: Sepsis disproportionately affects vulnerable populations, like the very young, the very old and the poor. Lower middle income countries have less infrastructure to deliver timely therapies, less monitoring capacity, less acute care delivery capacity, etc., and all of this is magnified in a setting with more poverty. In addition, sepsis is more common in settings of malnutrition, poor sanitation and where there are endemic infectious disease problems—for example, bacterial sepsis can be more severe in patients with a history malaria.
A: It aligns perfectly. Our epidemiologic and health services research focuses on ‘doing the simple things well’ in both rich and austere settings; our translational research on better patient phenotyping and more sophisticated manipulation of the body’s immune system, as well as better monitoring and care of vital organ dysfunction, is relevant too, because even when ‘current’ care is delivered optimally, as many as 1 in 4 patients still die. Thus, we need to not only ensure everyone gets the best version of today’s care, but we also need to keep an eye on how to deliver better care tomorrow.
An analysis covering nearly 50,000 patients from 149 New York hospitals is the first to offer scientific evidence that a controversial early sepsis care regulation worked. The announcement – led by the University of Pittsburgh School of Medicine – gives fuel to other states pursuing rapid sepsis care initiatives.
The new additions bring ISMETT’s total to 114 beds, up from 78 in 2011 in this government-accredited research hospital. The first Italian hospital dedicated solely to solid organ transplantation, ISMETT treats more than 30,000 patients a year with severe organ disease.
The new 10-bed pediatric department houses all single-patient rooms and a playroom, pharmacy and offices. In a separate cardiac wing, 23 additional adult beds have been added, along with a lounge and pharmacy. Space was also constructed to accommodate specialized medical equipment, including a vital-signs monitoring system and digital x-ray device.
On May 16, ISMETT officially celebrated its 20th anniversary with a ceremony attended by the mayor of Palermo, the president of the region and other top government and UPMC leaders, followed by a ribbon-cutting to officially open the new areas.
“We celebrate our past achievements as well as the bright future of this life-saving facility,” said Dr. Angelo Luca, director of ISMETT. “Thanks to investments made by the Region of Sicily and the expertise of our clinicians at ISMETT and UPMC, we are able to provide the most innovative and highly specialized therapies in the country.” Every year, he noted, a third of the patients are admitted under urgent conditions, and about 20 percent are referred from other hospitals, suggesting that ISMETT is fully integrated into the regional health care system. (more…)
Pittsburgh Three Rivers Marathon Inc. recently inducted Dr. Ron Roth to the Pittsburgh Marathon Hall of Fame. Roth serves as the marathon medical director, and is also chief of the division of emergency medical services at UPMC.
He resumed leading medical efforts for the weekend events since the revival of the Pittsburgh Marathon in 2009.
“I am the only inductee who has run 19 marathons but never crossed the finish line,” Roth said. “There have been many changes in the way we ‘run’ the marathon, now using the medical literature to bring cutting edge medical care to our runners. I am lucky to have an incredible team of providers from UPMC who help keep the runners safe along the course and at the finish line.”
The Dick’s Sporting Goods Pittsburgh Marathon draws athletes from all over the world and is known as one of the best U.S. marathons for medical assistance, much of this attributed to Roth and his UPMC staff.
The 2017 Dick’s Sporting Goods Pittsburgh Marathon is Sunday.
UPMC is the official medical provider for the event. The finish line medical tent and first aid stations located throughout the course will be packed with equipment and staff.
How many supplies and people will be helping the runners?
Here is a breakdown of the medical efforts from UPMC Sports Medicine, the University of Pittsburgh Department of Emergency Medicine, City of Pittsburgh Bureau of EMS, EMS agencies from Allegheny County and across the region, the American Red Cross, and more.
By the Numbers:
- 8,000 adhesive bandages
- 5,000 pairs of protective rubber gloves
- 4,800 alcohol wipe 4,000 tongue depressors
- 4,500 ice bags
- 2,100 lancets to treat blisters
- 475 Ace wraps
- 600 towels
- 500 leads (clips) for medical monitors
- 400+ feet of intravenous tubing (nearly 1/10 of a mile)
- 350 elastic bandages
- 200+ tourniquets
- 150 nausea bags
- 120 Red Cross-donated cots (for the finish line and aid stations)
- 125 jars of petroleum jelly (and one sign, warning runners that not every tongue depressor contains edible goo: “Don’t eat the Vaseline”)
- 100 sheets
- 75 flags: five for each aid station and the finish line representing weather-condition warnings – white for risk of hypothermia, green for low risk, yellow for moderate risk, red for high risk and black for emergency/leave the course
- 65+ physicians
- 50+ certified athletic trainers at the finish line and along the course
- 45+ nurses
- 30 students from graduate schools of medicine and nursing plus athletic training programs
- 27+ ambulances from a variety of agencies
- 16 aid stations along the course, including one start line and two Point State Park medical tents
- 9 motorized carts carrying EMTs, paramedics and equipment
- 7 Red Cross liaisons in local hospitals tracking injured runners, families there
- 6-7 City of Pittsburgh EMS units
- 6 ice-water immersion tubs
- 4 Wet Bulb Globe Temperature Index thermometers, to measure race conditions
- 4 medic posts at the finish line chutes
- 1 Medical Evacuation Rehab Vehicle (MERV)
- 1 finish line field hospital
- 1 to 3 percent of the runners (200 to 400) are typically treated at the race – half on the course, half at the finish line
- Weather is the No. 1 determining factor in race injuries