Sepsis Recognition

Sepsis is an out-of-control infection. It can be tricky to detect, and prehospital recognition relies heavily on the history of present illness (HPI). Indicators for increasing your index of suspicion include the following:

  • Recent infection – check for antibiotics on medication lists.
  • Abdominal distension and tenderness with positive rebound tenderness.
  • Strong smell of urine – check catheter bag for discolored urine and ask about urinary tract infection (UTI) history.
  • Recent illness – cough, cold/flu/covid symptoms.
  • Fever/hypothermia – not all sepsis has a fever.
  • Recent surgery.
  • Rashes – i.e., cellulitis.
  • Diabetes with skin lesions.
  • Pressure sores and wounds.
  • Immunocompromised – chemotherapy & AIDS.
  • Animal bites, especially cat scratches.

Systemic Inflammatory Response Syndrome, or “SIRS” criteria: If you have an index of suspicion for sepsis, you should consider SIRS criteria. If any ONE of the following are positive, consider activation of a “sepsis alert” and transporting to appropriate receiving facility.

  • Systolic BP <90 mmHg
  • Heart Rate >90/min
  • Respiratory rate >20/min
  • GCS <15
  • Temperature >100.40 F or <96.00 F

Note: Some EMS agencies have access to field lactate monitors. Local protocols will dictate usages and ranges for clinically significant elevation (usually above 4 mmol/L)

Sepsis Recognition Skill Verification Table

Sepsis Recognition


2 (instructor)


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Oregon EMS Psychomotor Skills Lab Manual Copyright © 2023 by Chris Hamper, BS, NRP; Carmen Curtz, Paramedic, BS; Holly A. Edwins, Paramedic, B.S.; and Jamie Kennel, PhD, MAS, NRP is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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