Guidelines that were proposed through the Surviving Sepsis Campaign to improve outcome in septic patients are difficult to apply routinely in most EDs. Attempts to apply these procedures fully have varied widely; diagnosis may be problematic because of atypical or unspecific presentations, biomarkers are of little help at the start of treatment and are unspecific, supportive treatment often depends on local supply of resources, and specific devices are often absent in EDs for initial therapy and monitoring. Even adherence to early administration of antibiotic therapy is poor, with delays being common. Our goal is now to improve the level of care by applying evidence-based procedures.