The state Department of Health, thanks in large part to the continued advocacy from a Warwick family, is going forward with the development of a series of protocols that would standardize how to be aware of, diagnose and treat sepsis, a life-threatening blood poisoning that can follow any common infection.
The state is currently researching best practices and identifying existing protocols elsewhere in the country, and plans to be reaching out to healthcare facilities and providers in October regarding the creation of these new protocols, with a goal of having a set of best practices developed by February of 2020.
The sudden death of 16-year-old Gianna Cirella, who died from complications of sepsis on November 1, 2017, sparked a community-wide movement of support for the family that, as Gianna’s mother Tara has said in the past, saved her from the unthinkable pain that accompanies such a tragic loss.
The family has since poured their grief into doing positive things for Warwick, creating the Gianna Cirella Memorial Fund in her memory shortly after her passing. The Fund has since created a scholarship program and partnered with the Rhode Island Blood Center, which according to Tara has helped bring in over 900 pints of blood from their two annual blood drives since Gianna’s death.
The Fund’s main mission is to raise awareness and bolster research into sepsis – which can occur when the body attempts to fight an infection and, in the span of just a couple weeks, took Gianna from having something as innocuous as a sore throat to losing her life.
Continuing their advocacy, the Cirellas have teamed up with state legislators and the State Department of Health to create something with even more of an impact, which could potentially save the lives of people in a similar situation to Gianna’s all throughout the state of Rhode Island.
“We don't just want to right the wrong, we want to make sure nobody else goes through this,” Tara said on Tuesday. “We lost a beautiful thing, but that doesn’t mean you can’t do anything about it.”
With the passing of House Resolution 5539 this most recent legislative session (sponsored by Warwick Reps. K Joseph Shekarchi, Camille Vella-Wilkinson, Joseph Solomon Jr., David Bennett and Evan Shanley) the Rhode Island Department of Health will be embarking on a mission to standardized specific protocols and procedures to better identify sepsis before and as it occurs so medical professionals will be better able to treat it and prevent deaths.
“This will include an evidence-based screening tool that can be used at initial evaluation of adult and pediatric patients in the emergency department; nurse-driven testing protocols to enable nurses to initiate care for patients with suspected sepsis; and incorporation of sepsis screening and treatment tools into the electronic health record where possible, among many other measures,” said Joseph Wendelken, public information officer for the Department of Health. “We are going to be working collaboratively with experts in the field from a variety of organizations.”
Tara said that Rhode Island’s sepsis framework will be based upon work done in other states, notably New York, which passed a similar system of protocols and procedures for sepsis in 2013 – the first in the nation to do so. Since then, Illinois and New Jersey have enacted similar protocols in 2016 and 2018 respectively.
The bill cites a 2018 study from the Centers for Medicare & Medicaid Services, which ranked Rhode Island as the fourth worst in the nation in terms of properly treating sepsis. It reports that about 200,000 people die each year from sepsis in the United States, which is more than AIDS, opioid overdoses and breast cancer deaths combined.
The impetus for creating a framework on how to identify and treat sepsis quickly stems from the fact that sepsis is a rapidly progressing condition that can begin with a vast variety of initial medical issues, many of which are not seen as severe. Sepsis is the leading cause of death of children in hospitals in Rhode Island and in the United States.
In Gianna’s case, she first presented with a sore throat. In the case of Rory Staunton – the 12-year-old boy from New York whose death prompted the creation of a foundation like Gianna’s – he suffered a minor scrape on his arm while playing in gym class. According to the Rory Staunton Foundation’s website, the family took multiple trips to doctors and hospitals only to have them chalk up Rory’s severe pain to a stomach virus. He died just a few days after his minor injury after developing sepsis.
Sepsis can develop from any type of infection and, if not caught and treated within a fast time frame, can cause organs to shut down one by one until recovery becomes impossible. According to Sepsis.org, “A 2006 study showed that the risk of death from sepsis increases by an average of up to 7.6 percent with every hour that passes before treatment begins.”
To recognize the symptoms of sepsis, the acronym TIME is used – meaning Temperature (irregularly high or low); Infection (which can present in many ways, and doctors should be able to recognize); Mental Decline (being confused, sleepy or difficult to wake; and Extremely Ill (feeling severe pain or discomfort).
While sepsis mostly affects very young or very young individuals, anybody can contract it and anybody can succumb to it if the infection is not treated promptly. The hope in developing a standardized framework is to raise awareness about sepsis and ensure that it is part of the diagnostic process for all medical centers in the state – from walk-in clinics and pediatrician offices to emergency rooms.
“The protocols and testing will be put in place throughout the state all the way through all the medical providers so that sepsis will be recognized immediately if there are indicating factors and they'll know how to treat it effectively and quickly so that there are no more cases like Gianna's,” said Tara.