Over the past two years, simultaneous with the departure of Dr. Dellinger from the SSC, the collaborative culture changed. Although the majority of sepsis patients are identified and initially treated outside of the ICU, clinical perspectives from service lines such as emergency medicine, hospitalists, nurses, or infectious disease were not considered when developing definitions. This decision resulted in reduced uptake. Additionally, a few months after completing a yearlong process of guideline development, SSC executive committee members, independent of the multispecialty guideline committee, published the Hour-1 Bundle. This bundle, directed toward ED practice without representation from the emergency medicine community and without review by the multispecialty SSC Guidelines Committee, is misguided and should serve as an alarming precedent for all professional organizations participating in the SSC. When a letter to the editor was written in response to the Hour-1 Bundle, it was not published due to a Society of Critical Care Medicine (SCCM) policy of having concerns directed to the guideline committee chair.

This is a challenging time. ACEP is working diligently with SCCM and the SSC. Although individual service lines can incrementally impact mortality, no service line can truly optimize sepsis survival alone. From 2003 to 2015, patient survival has improved due in part to this global cooperative work. I hope we can get back to the real mission, caring for the patients we are called upon to serve. Our patients need us all to be more than individual service lines; they need us to provide a service.

Part 2 of this history will appear in the December issue.

Complete the CME activity.

Dr. Osborn is professor of surgery and emergency medicine at Barnes-Jewish Hospital/Washington University in St. Louis, Missouri.

References

1. Rosen P. The biology of emergency medicine. JACEP. 1979;8(7):280-283.
2. Martin GS, Mannino DM, Eaton S, et al. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546-1554.
3. Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303-1310.
4. Salvo I, de Cian W, Musicco M, et al. The Italian SEPSIS study: preliminary results on the incidence and evolution of SIRS, sepsis, severe sepsis and septic shock. Intensive Care Med. 1995;21(Suppl 2):S244-S249.
5. Osborn TM, Tracy JK, Dunne JR, et al. Epidemiology of sepsis in patients with traumatic injury. Crit Care Med. 2004;32(11):2234-2240.
6. Levy MM, Rhodes A, Phillips GS, et al. Surviving sepsis campaign: association between performance metrics and outcomes in a 7.5-year study. Crit Care Med. 2015;43(1):3-12.
7. Wang HE, Shapiro NI, Angus DC, et al. National estimates of severe sepsis in United States emergency departments. Crit Care Med. 2007;35(8):1928-1936.
8. Gaieski DF, Goyal M. What is sepsis? What is severe sepsis? What is septic shock? Searching for objective definitions among the winds of doctrines and wild theories. Expert Rev Anti Infect Ther. 2013;11(9):867-871.
9. Van Arsdale WW. I. On the present state of knowledge in bacterial science in its surgical relations (continued): sepsis. Ann Surg. 1886;3(4):321-333.
10. Bone RC, Sibbald WJ, Sprung CL. The ACCP-SCCM consensus conference on sepsis and organ failure. Chest. 1992;101(6):1481-1483.
11. Bone RC, Fisher CJ Jr, Clemmer TP, et al. A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. New Engl J Med. 1987;317(11):653-658.
12. Bone RC, Fisher CJ Jr, Clemmer TP, et al. Sepsis syndrome: a valid clinical entity. Methylprednisolone Severe Sepsis Study Group. Crit Care Med. 1989;17(5):389-393.
13. Vincent JL. Dear SIRS, I‘m sorry to say that I don‘t like you…. Crit Care Med. 1997;25(2):372-374.
14. Marshall JC. Sepsis definitions: a work in progress. Crit Care Clin. 2018;34(1):1-14.
15. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med. 2003;29(4):530-538.
16. Angus DC, Seymour CW, Coopersmith CM, et al. A framework for the development and interpretation of different sepsis definitions and clinical criteria. Crit Care Med. 2016;44(3):e113-121.
17. Nazzal M, Sun Y, Okoye O, et al. Reno-portal shunt for liver transplant, an alternative inflow for recipients with grade III-IV portal vein thrombosis: tips for a better outcome. Int J Surg Case Rep. 2017;41:251-254.
18. Abraham E. New definitions for sepsis and septic shock: continuing evolution but with much still to be done. JAMA. 2016;315(8):757-759.
19. Klauer K. A marriage of old data and new concepts: new sepsis definitions raise concerns about accuracy, usefulness in emergency medicine. ACEP Now. 2016;35(7):1,12-13.
20. Slesinger TL, Dubensky L. Sepsis-3, a new definition. Solutions or new problems? ACEP website. Accessed Oct. 18, 2018.
21. Lo RS, Brabrand M, Kurland L, et al. Sepsis–where are the emergency physicians? Eur J Emerg Med. 2016;23(3):159.
22. Simpson SQ. New sepsis criteria: a change we should not make. Chest. 2016;149(5):1117-1118.
23. Cortés-Puch I, Hartog CS. Opening the debate on the new sepsis definition change is not necessarily progress: revision of the sepsis definition should be based on new scientific insights. Am J Respir Crit Care Med. 2016;194(1):16-18.
24. Why LASI did not endorse the new definitions of sepsis published today in JAMA. Instituto Latino Americano de Sepse website. Accessed Oct. 18, 2018.
25. Henning DJ, Puskarich MA, Self WH, et al. An emergency department validation of the SEP-3 sepsis and septic shock definitions and comparison with 1992 consensus definitions. Ann Emerg Med. 2017;70(4):544-552.