Knowledge, attitudes, and practices of pre-hospital emergency medical care practitioners regarding sepsis recognition: a cross-sectional study in Qatar

BACKGROUND: Sepsis remains a leading cause of global morbidity. Early recognition is frequently delayed due to heterogeneous clinical presentations and the absence of definitive diagnostic tools, particularly in the pre-hospital setting. This study assessed the knowledge, attitudes, and practices (KAP) of pre-hospital emergency medical care (PHEMC) practitioners at Hamad Medical Corporation Ambulance Service (HMCAS) in Qatar to evaluate sepsis recognition and inform context-specific strategies for improving pre-hospital care. METHODS: A cross-sectional study was conducted within HMCAS using a 53-item survey developed through literature synthesis, expert review, and pilot testing. Analyses were primarily descriptive, with exploratory bivariate testing of associations between practitioner characteristics and KAP measures. A multiple linear regression model was constructed to identify predictors of diagnostic confidence using confidence in prompt and accurate sepsis diagnosis as the dependent variable. RESULTS: Of the 221 licensed practitioners who completed the survey, most were male (90%) and aged 31-40 years. Only 33.5% of respondents correctly determined that the patient in Scenario 1 did not have sepsis, whereas 79.2% correctly identified sepsis in Scenario 2, which represented a more overt septic presentation. Although 59.7% reported considering sepsis even in the absence of fever or a clear source of infection, scenario-based accuracy did not reflect this self-reported awareness. Awareness of screening tools was common, but their use was predominantly reactive, occurring after clinical suspicion had already been established. Diagnostic confidence was highest among practitioners who had received recent/up-to-date sepsis training (p < 0.001). CONCLUSION: Despite widespread awareness and training, early-stage sepsis recognition among PHEMC practitioners in Qatar remains inconsistent and largely reactive. Self-reported confidence and familiarity with screening tools did not reliably translate into accurate determination of whether sepsis was present, highlighting a gap between perceived and actual competence. These findings suggest that improving pre-hospital sepsis recognition may require system-level and behavioural interventions in addition to education.