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Objective: Despite high in‐hospital mortality, the epidemiology of prehospital suspected sepsis presentations is not well described. This retrospective cohort study aimed to quantify the burden of such presentations, and to determine whether such a diagnosis was independently associated with longer‐term mortality. Methods: Retrospective, observational population‐based cohort study examining all adult prehospital presentations in Victoria, between January 2015 and June 2019, who required subsequent in‐hospital assessment. Linked data were extracted from clinical and administrative datasets. Demographics, illness severity, prehospital treatment and mortality were compared between prehospital suspected sepsis and non‐sepsis patients. Multivariable logistic regression was used to determine the adjusted association between prehospital assessment (suspected sepsis vs non‐sepsis) and 6‐month mortality. Results: A total of 1 218 047 patients were included. The age‐adjusted incidence rate of prehospital suspected sepsis was 65 cases per 100 000 person‐years. Those with prehospital suspected sepsis were older (74 vs 62 years), more frequently male (55% vs 47%), with greater physiological derangement. Intravenous cannulas were more often inserted prehospital (60% vs 29%). Crude in‐hospital mortality was 6.5‐fold higher in the prehospital suspected sepsis group (11.8% vs 1.8%), and by 6 months, 22.6% had died. After adjustment for demographics, illness severity, comorbidity, treatment and hospital location, a diagnosis of prehospital suspected sepsis was associated with a 35% higher likelihood of 6‐month mortality (OR 1.35, 95% CI 1.29–1.41). Conclusions: The burden of prehospital suspected sepsis in the Australian setting is significant, with paramedics identifying patients at high‐risk of poor longer‐term outcomes. This implies the need to consider improved care pathways for this highly vulnerable group. [ABSTRACT FROM AUTHOR]