• Nadia Alam, de Ven Peter M van PM Department of Epidemiology and Biostatistics, VU University Amsterdam, The Netherlands., Erick Oskam, Patricia Stassen, Mark Hh Kramer, Exter Pieternel van PV Ambulance Amsterdam, The Netherlands., and Nanayakkara Prabath Wb PW Section acute medicine, Department of Internal Medicine and Institute of Cardiovascular research, VU University Medical Centre, Amsterdam, The N.
• Section acute medicine, Department of Internal Medicine and Institute of Cardiovascular research, VU University Medical Centre, Amsterdam, The Netherlands.
• Acute Med. 2016 Jan 1; 15 (4): 176-184.

IntroductionSepsis is one of the most frequent reasons for referral to emergency departments (EDs) worldwide. Sepsis becomes more serious when left untreated with a high mortality rate, exceeding even those of myocardial infarction and stroke. Therefore, much effort has been put in to start with appropriate therapy as early as possible. Emergency medical services (EMS) personnel have already made a significant difference in improving care for patients with acute coronary syndrome, multiple trauma and stroke. Patients with severe sepsis or septic shock could also benefit from timely prehospital care. Earlier recognition and initiation of treatment by EMS personnel may improve survival of these critically ill patients. Methods and analysis: The Prehospital Antibiotics against Sepsis (PHANTASi) trial is an investigator- initiated, multicentre, randomized controlled open-label clinical trial nested within a step wedge design. This study compares the effects of usual care to that of training EMS personnel in recognizing and initiating treatment in the prehospital setting together with early administration of antibiotics for patients suspected of (severe) sepsis and septic shock. Primary outcome is 28 day mortality. Secondary outcomes include, length of hospital stay and admission to intensive care units. Ethics and dissemination: This study has been approved by the research ethics committee of VU University Medical Centre, Amsterdam, The Netherlands (Protocol 2013.458/ NL 42001.029.13). The results of the study will be disseminated at several research conferences and international peer reviewed journals. The study will be implemented and reported in line with the CONSORT statement.

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