Jem Abbotts was a healthy 37-year-old father of two when he decided to have a vasectomy, a routine procedure tens of thousands of men undergo successfully every year.
Within ten days he would be dead, killed by sepsis, a deadly condition that, if spotted in time, is easy to treat. The sales executive from Sutton Coldfield underwent his vasectomy at the Sir Robert Peel Hospital in Tamworth, Staffordshire. It went well, but at some point Jem developed an infection.
Six days later, his wife Karen recalls that Jem came home saying he felt ‘really ill, like he had flu, so I told him to go to bed and rest’.
It wasn’t flu. Jem was feeling the effects of sepsis. This fast-moving condition occurs when the body’s immune system over-reacts to an infection, caused by anything from a cut finger to the flu, attacking not only invading bugs but also its own tissues and organs, shutting them down one by one.
That Thursday night Jem was sick several times. The next day ‘he still felt rotten’, so Karen called the GP, who visited that afternoon. Despite the vomiting and flu-like symptoms, the GP put Jem’s condition down solely to an infection from the surgery.
He prescribed antibiotics but didn’t consider the much more serious possibility of sepsis.
When he woke on Friday Jem complained of feeling cold and had developed strange mottling down one side. Both symptoms, caused by low blood pressure, were two telltale signs of sepsis. But it was Saturday before he finally gave in to his family’s pleas to go to hospital.
It was already too late.
Jem had started to become disorientated and by the time the ambulance arrived ‘he was in almost a drunk-like state’, recalls Karen, 45. It was the last time Karen would see her husband awake.
At the hospital his heart stopped; they got it working again in intensive care but he never regained consciousness.
Many professionals unaware: Sepsis is one of the greatest - and possibly least well-known - health threats
The last sight his children Emily, then 11, and Tom, eight, had of their father was of him attached to a life-support machine, which was finally switched off three days later.
Just before he died, Karen was told Jem had fallen victim to sepsis. ‘I didn’t even know what it was,’ she says now.
An inquest in March 2005 concluded no one had been to blame for Jem’s death.
COUGH THAT LED TO LOST LIMBS
sepsis can strike anyone, but death is far from inevitable.
It is easy to treat with a strong dose of antibiotics, delivered intravenously, as well as fluids; however it’s largely unknown to the public and poorly recognised by doctors.
Last week, the Mail launched a campaign to increase awareness of the dangers of sepsis, a campaign supported by the mother of William Mead, the one-year-old Cornish boy killed by sepsis in 2014 after warning signs were missed by doctors and the NHS 111 helpline.
Every year 44,000 people in the UK are killed by sepsis.
What’s more, while 100,000 survive, many are left with serious long-term complications, such as irreversible damage to lungs, heart, kidneys and brain, and limb amputations.
In yet another sign of the NHS’s failure to respond properly to sepsis, there is no national register of cases, so it’s not known for certain how many who survive sepsis are affected in the long term, though it’s thought as many as 30 per cent will have a significant complication, says Dr Ron Daniels of the UK Sepsis Trust.
There’s little doubt how much sepsis survivor Corinne Hutton’s life has been changed by the condition. In June 2013, the 43-year-old mother-of-one developed a cough.
At the time, she was running her own design company and she tried over-the-counter medication, but after two weeks saw her GP. He prescribed He prescribed antibiotics for a suspected respiratory infection.
‘I went home, feeling poorly like you would if you had a chest infection, and went to bed,’ says Corinne, who lives in Lochwinnoch in Renfrewshire. ‘The next day, I was dying in hospital.’
That morning she’d stayed in bed, while her four-year-old son Rory was looked after by his father. About mid-morning she became alarmed when she vomited blood.
‘I still thought I just needed the antibiotics to work, but with a bit of bullying from my mum I phoned NHS 24 [Scotland’s NHS 111].’ She was advised to go to the walk-in clinic at the Royal Alexandra Hospital in Paisley. Seen immediately by a consultant, she managed to utter just a few words before passing out.
‘I wasn’t expected to survive,’ she says. ‘Within hours of my getting to hospital my brother was on a plane from Dubai with his black suit.’
As her blood pressure plummeted, starving her body of oxygen, Corinne’s organs began to shut down. Sepsis had set in. She was in a medically induced coma for the next three weeks, as doctors fought to save her life.
When she finally came round, she had been transferred 300 miles by air to a specialist treatment unit at Glenfield Hospital, Leicester.
Three weeks later she learned that both her hands and feet would have to be amputated.
In all, she underwent 13 different procedures, carried out in six gruelling bouts of surgery.
She was in hospital for three months. Two-and-a-half years on, Corinne, now 45, is getting on with her life, and launched Finding Your Feet, a charity dedicated to helping people who have lost limbs.
But she remains haunted by the way her life was turned upside down by a simple cough. In her case, she says: ‘Nobody really did anything wrong, but that is what’s so frightening, not just for me but for anyone who finds themselves in the same boat.’
THE SIMPLE TESTS DOCTORS DON'T DO
Our campaign is calling for a radical improvement in the way the NHS tackles sepsis.
Go into hospital with sepsis in England, and you have a 30 per cent chance of dying. In Wales or Scotland, your odds improve dramatically — with death rates at 24 per cent and 20 per cent respectively. In the U.S., some hospitals have rates as low as 9 per cent. In each case, a simple, but effective, system of detection and treatment is in place, reinforced with awareness training for hospital doctors, nurses and pharmacists.
Ironically, many of these systems — including those in Wales and Scotland — are based on the Sepsis Six, developed in England by the Birmingham-based UK Sepsis Trust.
The Sepsis Six comprises three tests (two blood tests and a urine check) and three treatments — antibiotics, intravenous fluids and oxygen — that must be given within the all important ‘golden hour’ of sepsis first even being suspected.
Where the Sepsis Six is in consistent use by the NHS in England, death rates are closer to 20 per cent than the national average of 30 per cent.
It’s estimated that as many as 14,000 lives could be saved in England every year if only doctors followed these well-established protocols.
The Sepsis Six protocols were developed by Dr Ron Daniels — who was prompted to act when he was a junior critical care consultant at Good Hope Hospital, Birmingham, when Jem Abbotts died there in March 2004.
‘I came into work one Monday morning and found myself having to explain to Karen that her 37-year-old husband was going to die,’ he told Good Health. ‘She was going to have to go home and tell their two young children that Daddy wasn’t coming home, all from something that was essentially preventable.’
Driven by Jem’s death, Dr Daniels began working to raise awareness of the condition, first locally among colleagues and then nationally, and in 2012 he and colleagues from Birmingham founded The UK Sepsis Trust.
(Today, Good Hope Hospital has one of the best mortality rates for sepsis in England — 20 per cent.)
The charity is now widely recognised as the leading UK authority on the condition and has now introduced the Sepsis Six programme to the vast majority of British hospitals.
But ‘there’s a problem’, says Dr Daniels. ‘While 94 per cent of hospitals say they use the system, it doesn’t mean they use it with everyone.
‘There are places now delivering The Sepsis Six in 90 per cent of cases, but they are few and far between.’
SAVE LIVES BY EDUCATING STAFF
The problem, he says, is that NHS England seems unable to impose the type of system-wide direction that others have found so vital in improving sepsis care.
Compare this with Scotland. In January 2012, NHS Scotland launched a three-year campaign aimed at improving recognition, assessment and timely treatment of sepsis.
Training sessions for everyone involved with patients, from doctors and nurses to pharmacists and administration staff, were reinforced by posters, regular safety briefings, talks by patients and relatives of people who had died from sepsis, and even a specially developed sepsis screening app. But at the heart of it all was the Sepsis Six.
At the start, with a mortality rate of 24.8 per cent, NHS Scotland’s sepsis record was already better than that in England, but the campaign drove the death rate down to 19.5 per cent.
The man behind the programme is Professor Kevin Rooney, an intensive care consultant at the Royal Alexandra Hospital in Paisley and Scotland’s national clinical lead for sepsis.
A dedicated central team was set up to oversee the changes, but he gives credit for the lives saved to the Scottish government.
‘We’ve been very fortunate,’ he told Good Health. ‘We identified this as a problem and right from the start we’ve had top-level support from the Scottish government and the chief executive of the NHS in Scotland.’
As a result, ‘every hospital in NHS Scotland has been working on sepsis because they have been told, “You have to do this.” ’ The response in England has lacked such central direction, says Dr Daniels.
FAILING TO TACKLE THE PROBLEM
In 2013, the Parliamentary and Health Service Ombudsman investigated several cases in which patients had died from sepsis and concluded they ‘did not receive the treatment they urgently needed’.
In a third of cases ‘existing care standards and protocols are not being followed’. In response, in December NHS England launched ‘Improving outcomes for patients with sepsis’, a ‘cross-system action plan’.
But the problem, says Dr Daniels, who worked on the action plan, is ‘it is just another report — what we need, and don’t have, is a national central team acting on this, driving change.’
A spokesperson for NHS England declined to explain why its mortality rate for sepsis was so much worse than in Scotland or Wales. However, she suggested it was ‘possible that differences in clinical coding may in part explain the disparities in different areas’.
The battle against sepsis also needs proper funding, says Dr Daniels, but he doubts that a financial incentive recently put in place by NHS England fits the bill.
THE SHORT-FALL IN SPECIALIST NURSES
Under this system, local health authorities (known as clinical commissioning groups) can withhold money which a hospital can ‘claw back’ by meeting certain standards.
In the case of sepsis, about 30 per cent of hospitals have qualified for the money by appointing a specialist nurse to improve the response to sepsis across the hospital.
But the evidence on the scheme collected last year by the All-Party Parliamentary Group on Sepsis was shocking: trusts expected to claw back an average of £660,000 each on sepsis, but were planning to invest just £64,000 in services to do so.
‘If trusts are going to invest only £60,000, it’s not surprising that we don’t yet have a reliable standard of care for what is a complex problem,’ says Dr Daniels.
WE NEED SEPSIS ‘CRACK TEAMS’
A far better incentive would be to reward trusts for setting up ‘Code Sepsis’ teams, like in U.S. hospitals, akin to the crash teams on standby to respond to cardiac arrests but ready to start vital treatment as soon as sepsis is suspected.
For Karen Abbotts, the day when all hospitals offer the same high level of sepsis care can’t come soon enough. Until then, she knows that patients and their loved ones must be on guard, which is why she backs the call for a national awareness campaign.
‘Jem was dying when he went into hospital,’ she says. ‘If I’d taken him a lot sooner it might have been a different story. We’ll never know.’
THE LITTLE GIRL LEFT WITH LEARNING PROBLEMS...
IDENTICAL twin Tilly Moores (below, left) contracted sepsis when she was just seven months old.
Her older sisters and her twin came down with chickenpox, as did Tilly — but then her parents Mandy, a chemistry teacher, and Guy, a dentist, noticed an infected spot on Tilly’s chest.
The Moores, from Henstridge in Somerset, took Tilly first to the out-of-hours clinic at Yeovil Hospital and then to A&E when her condition worsened.
Affected: Mandy Moores and daughters Tilly (left) and Lucy, both 7, pictured at home near Yeovil, Somerset
‘No one could tell me what was wrong and she was clearly getting worse,’ says Mandy.
When she developed a body rash, Tilly was transferred — with medical team and on life support — to a paediatric intensive care unit 80 miles away in Southampton.
Mandy and Guy kept vigil by her side for a week while she was in an induced coma.
After three weeks their baby girl was discharged — but lack of oxygen caused by sepsis has ‘definitely affected her, learning-wise and developmentally’, says Mandy. ‘Afterwards Tilly would reach milestones — crawling, walking, talking — a lot later than her twin, Lucy,’ says Mandy.
Now seven, the twins are at the same primary school, but her mum says that Tilly ‘is operating as a five-year-old in terms of academic ability.’
Quick-thinking: When she developed a body rash, Tilly was transferred — with medical team and on life support — to a paediatric intensive care unit 80 miles away in Southampton
Lasting effects: The twins are now at the same primary school, but her mum says that Tilly ‘is operating as a five-year-old in terms of academic ability’
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