1629: Time to Hospital Among Adults With Suspected Sepsis and Shock: A National Time-Component Analysis

Introduction: Patients needing urgent hospitalization for sepsis face unique challenges in rural (e.g., distance) and urban (e.g., congestion) areas which might contribute to poor outcomes. Understanding pre-hospital delays along the Emergency Medical Services (EMS) response continuum might optimize care delivery and save lives. Methods: All adult ground EMS activations with an EMS impression of sepsis, (and for comparison, acute myocardial infarction (MI), stroke, and trauma) were identified from 48 U.S. states between 2018 – 2023 in the National EMS Information System database. For each condition, multivariable linear regression was used to evaluate the effect of rurality on total and component (scene, transport, wall) EMS times controlling for patient (age, sex, initial acuity), EMS (level of care, rush hour, hospital critical access status, and US region) and pandemic-related confounders. Shock (vasopressor initiation and/or end tidal CO2 < 25 mmHg) was introduced as an interaction term. Results: For 38,876,386 EMS sepsis encounters, crude median (IQR) total, scene, transport and wall time were 44.5 (34.0 – 58.2), 16.9 (12.3 – 22.1), 12.7 (8.0 – 18.4), and 9 (4.0 – 17) minutes respectively. Compared to urban areas, risk-adjusted total EMS time was 0.2 (95% CI: -0.19 – 0.60) min shorter in rural areas for sepsis without shock, but 8.5 (95% CI: 7.55 - 9.36) min longer with shock. Component analyses revealed longer transport time (10.4 min, 95% CI: 9.89 - 10.8), longer scene time (1.84 min, 95% CI: 1.50 – 2.18) but shorter wall time (3.95 min, 3.28 – 4.63) in rural (vs urban) areas for sepsis with shock. Activations were even longer in rural (vs urban) areas for patients in shock from acute MI, stroke, and trauma going to PCI-capable (17.95 min, 95% CI: 16.56 – 19.34), stroke (17.9 min, 95% CI: 16.80 – 19.02), and trauma (22.9 min, 95% CI: 21.78 – 23.96) centers, respectively. Conclusions: For all time-sensitive conditions, the presence of shock prompted faster arrival to hospitals in urban vs rural environments. Prehospital rural delays for septic shock were predominantly related to longer transport times and occurred despite the lesser need for intervention-capable centers. Identifying operational factors for transport efficiency in rural areas could save lives.