Thermal variations in the patient compartment of an emergency ambulance: A feasibility study in an Irish context (original) (raw)
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Cabin temperature during prehospital patient transport – a prospective observational study
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Background Few studies have investigated the patient compartment temperatures during ambulance missions or its relation to admission hypothermia. Still hypothermia is a known risk factor for increased mortality and morbidity in both trauma and disease. This has special relevance to our sub-arctic region’s pre-hospital services, and we prospectively studied the environmental temperature in the patient transport compartment in both ground and air ambulances. Methods We recorded cabin temperature during patient transport in two ground ambulances and one ambulance helicopter in the catchment area of the University Hospital of North Norway using automatic temperature loggers. The data were collected for one month in each of the four seasons. We calculated the sum of degrees Celsius below 18 min by minute to describe the patient exposure to unfavourably low cabin temperature, and present the data as box plots. The statistical differences between transport mode and season were analysed wit...
Patients’ experiences of cold exposure during ambulance care
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2013
Background: Exposure to cold temperatures is often a neglected problem in prehospital care. Cold exposure increase thermal discomfort and, if untreated causes disturbances of vital body functions until ultimately reaching hypothermia. It may also impair cognitive function, increase pain and contribute to fear and an overall sense of dissatisfaction. The aim of this study was to investigate injured and ill patients' experiences of cold exposure and to identify related factors.
Scandinavian journal of trauma, resuscitation and emergency medicine, 2017
Hypothermia is common in trauma victims and is associated with increased mortality, however its causes are little known. The objective of this study was to identify the risk factors associated with hypothermia in prehospital management of trauma victims. This was an ancillary analysis of data recorded in the HypoTraum study, a prospective multicenter study conducted by the emergency medical services (EMS) of 8 hospitals in France. Inclusion criteria were: trauma victim, age over 18 years, and victim receiving prehospital care from an EMS team and transported to hospital by the EMS team in a medically equipped mobile intensive care unit. The following data were recorded: victim demographics, circumstances of the trauma, environmental factors, patient presentation, clinical data and time from accident to EMS arrival. Independent risk factors for hypothermia were analyzed in a multivariate logistic regression model. A total of 461 trauma patients were included in the study. Road traffi...
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2011
Background: Prevention and treatment of hypothermia by active warming in prehospital trauma care is recommended but scientifical evidence of its effectiveness in a clinical setting is scarce. The objective of this study was to evaluate the effect of additional active warming during road or air ambulance transportation of trauma patients. Methods: Patients were assigned to either passive warming with blankets or passive warming with blankets with the addition of an active warming intervention using a large chemical heat pad applied to the upper torso. Ear canal temperature, subjective sensation of cold discomfort and vital signs were monitored. Results: Mean core temperatures increased from 35.1°C (95% CI; 34.7-35.5°C) to 36.0°C (95% CI; 35.7-36.3°C) (p < 0.05) in patients assigned to passive warming only (n = 22) and from 35.6°C (95% CI; 35.2-36.0°C) to 36.4°C (95% CI; 36.1-36.7°C) (p < 0.05) in patients assigned to additional active warming (n = 26) with no significant differences between the groups. Cold discomfort decreased in 2/3 of patients assigned to passive warming only and in all patients assigned to additional active warming, the difference in cold discomfort change being statistically significant (p < 0.05). Patients assigned to additional active warming also presented a statistically significant decrease in heart rate and respiratory frequency (p < 0.05). Conclusions: In mildly hypothermic trauma patients, with preserved shivering capacity, adequate passive warming is an effective treatment to establish a slow rewarming rate and to reduce cold discomfort during prehospital transportation. However, the addition of active warming using a chemical heat pad applied to the torso will significantly improve thermal comfort even further and might also reduce the cold induced stress response.
International Journal of Circumpolar Health, 2015
Background. The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients' exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients' temperatures in the prehospital emergency care. Methods. A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n 030) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n 030) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures. Results. Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p 00.001) but decreased in the control group (p 00.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, pB0.001). At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes. Conclusions. The use of active heat from underneath increases the patients' thermal comfort and may prevent the negative consequences of cold stress.
Body temperature measurement in ambulance: a challenge of 21-st century?
BMC Emergency Medicine
Background: Some crucial decisions in treatment of hypothermic patients are closely linked to core body temperature. They concern modification of resuscitation algorithms and choosing the target hospital. Under-as well as over-estimation of a patient's temperature may limit his chances for survival. Only thermometers designed for core temperature measurement can serve as a guide in such decision making. The aim of the study was to assess whether ambulance teams are equipped properly to measure core temperature. Methods: A survey study was conducted in collaboration with the Health Ministry in April 2018. Questionnaires regarding the model, number, and year of production of thermometers were sent to each pre-hospital unit of the National Emergency Medical System in Poland. Results: A total of 1523 ground ambulances are equipped with 1582 thermometers. 53.57% are infrared-based ear thermometers, 23.02% are infrared-based surface thermometers, and 20.13% are conventional medical thermometers. Only 3.28% of devices are able to measure core body temperature. Most of analyzed thermometers (91.4%) are not allowed to operate in ambient temperature below 10°C. Conclusions: There are only 3.28% of ground ambulances that are able to follow precisely international guidelines regarding a patient's core body temperature. A light, reliable thermometer designed to measure core temperature in pre-hospital conditions is needed.
Impact of extreme temperatures on ambulance dispatches in London, UK
Environmental Research, 2020
Background: Associations between extreme temperatures and health outcomes, such as mortality and morbidity, are often observed. However, relatively little research has investigated the role of extreme temperatures upon ambulance dispatches. Methods: A time series analysis using London Ambulance Service (LAS) incident data (2010-2014), consisting of 5,252,375 dispatches was conducted. A generalized linear model (GLM) with a quasi-likelihood Poisson regression was applied to analyse the associations between ambulance dispatches and temperature. The 99 th (22.8°C) and 1 st (0.0°C) percentiles of temperature were defined as extreme high and low temperature. Fourteen categories of ambulance dispatches were investigated, grouped into 'respiratory' (asthma, dyspnoea, respiratory chest infection, respiratory arrest and chronic obstructive pulmonary disease), 'cardiovascular' (cardiac arrest, chest pain, cardiac chest pain RCI, cardiac arrhythmia and other cardiac problems) and 'other' non-cardiorespiratory (dizzy, alcohol related, vomiting and 'generally unwell') categories. The effects of long-term trends, seasonality, day of the week, public holidays and air pollution were controlled for in the GLM. The lag effect of temperature was also investigated. The threshold temperatures for each category were identified and a distributed lag non-linear model (DLNM) was reported using relative risk (RR) values at 95% confidence intervals. Results: Many dispatch categories show significant associations with extreme temperature. Total calls from 999 dispatches and 'generally unwell' dispatch category show significant RRs at both low and high temperatures. Most respiratory categories (asthma, dyspnoea and RCI) have significant RRs at low temperatures represented by with estimated RRs ranging from 1.392 (95%CI: 1.161-1.699) for asthma to 2.075 (95%CI: 1.673-2.574) for RCI. The RRs for all other non-cardiorespiratory dispatches were often significant for high temperatures ranging from 1.280 (95% CI: 1.128-1.454) for 'generally unwell' to 1.985 (95%CI: 1.422-2.773) for alcohol-related. For the cardiovascular group, only chest pain dispatches reported a significant RR at high temperatures. Conclusions: Ambulance dispatches can be associated with extreme temperatures, dependent on the dispatch category. It is recommended that meteorological factors are factored into ambulance forecast models and warning systems, allowing for improvements in ambulance and general health service efficiency.
Equipment to prevent, diagnose, and treat hypothermia: a survey of Norwegian pre-hospital services
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2013
Introduction: Hypothermia is associated with increased morbidity and mortality in trauma patients and poses a challenge in pre-hospital treatment. The aim of this study was to identify equipment to prevent, diagnose, and treat hypothermia in Norwegian pre-hospital services. Method: In the period of April-August 2011, we conducted a survey of 42 respondents representing a total of 543 pre-hospital units, which included all the national ground ambulance services, the fixed wing and helicopter air ambulance service, and the national search and rescue service. The survey explored available insulation materials, active warming devices, and the presence of protocols describing wrapping methods, temperature monitoring, and the use of warm i.v. fluids. Results: Throughout the services, hospital duvets, cotton blankets and plastic "bubble-wrap" were the most common insulation materials. Active warming devices were to a small degree available in vehicle ambulances (14%) and the fixed wing ambulance service (44%) but were more common in the helicopter services (58-70%). Suitable thermometers for diagnosing hypothermia were lacking in the vehicle ambulance services (12%). Protocols describing how to insulate patients were present for 73% of vehicle ambulances and 70% of Search and Rescue helicopters. The minority of Helicopter Emergency Medical Services (42%) and Fixed Wing (22%) units was reported to have such protocols.
Medical Studies, 2020
Introduction: Precise assessment of core body temperature is required for the optimal treatment of hypothermic patients according to European Resuscitation Council (ERC) guidelines. Core temperature is the cutoff criterion for some crucial therapeutic decisions in the treatment of severe hypothermia. Because the medical equipment is expensive, it is likely that pre-hospital services are equipped according to the minimal legal requirements. Aim of the research: To identify the legal provisions for suitable equipment and staff eligibility for core temperature measurement in European emergency medical services. Material and methods: The questionnaires that consisted of two questions pertaining to legal regulations were distributed among Ministries of Health and ERC representatives in every country of the European Union. Results: Eighteen out of 28 countries returned completed questionnaires. None of the analysed countries have official legal requirements regarding ambulance equipment with thermometers suitable for measuring core temperature. Most of the analysed countries have no legal provisions pertaining to the eligibility of medical staff to measure core temperature in ambulances. Conclusions: Official regulations in European countries do not require emergency medical services to be equipped with thermometers suitable for measuring core temperature. Medical staff eligibility in this field has not been established in most countries. This may limit the possibilities for pre-hospital management of hypothermic patients according to ERC guidelines. Streszczenie Wprowadzenie: Prawidłowe postępowanie z pacjentem w hipotermii opisane w wytycznych Europejskiej Rady Resuscytacji (ERC) wymaga dokładnego pomiaru temperatury głębokiej ciała. Zgodnie z tymi wytycznymi temperatura głęboka jest punktem odcięcia dla szeregu kluczowych decyzji terapeutycznych, takich jak wstrzymanie podawania leków lub ograniczenie liczby prób defibrylacji elektrycznej. Również decyzja o transporcie pacjenta do ośrodka, który posiada ogrzewanie pozaustrojowe, ściśle zależy od temperatury. Ze względu na koszty sprzętu medycznego można się spodziewać, że służby ratownicze otrzymują wyposażenie na minimalnym poziomie wymaganym przez przepisy prawa. Cel pracy: Ocena uregulowań prawnych dotyczących wyposażenia ambulansów i uprawnień personelu medycznego w zakresie pomiaru temperatury głębokiej na etapie przedszpitalnym w krajach Unii Europejskiej. Implementation of European Resuscitation Council guidelines: measurement of core body temperature in Emergency Medical Services in Europe Medical Studies/Studia Medyczne 2020; 36/1 Materiał i metody: Przeprowadzono badanie ankietowe. Ankietą objęto ministerstwa zdrowia oraz lokalne przedstawicielstwa ERC we wszystkich krajach Unii Europejskiej. Wyniki: Odpowiedzi uzyskano z 18 spośród 28 krajów. W żadnym z państw nie ma oficjalnych wymagań dotyczących wyposażenia ambulansów w termometry przystosowane do pomiaru temperatury głębokiej. Większość krajów nie zdefiniowała uprawnień personelu medycznego do takiego pomiaru w okresie przedszpitalnym. Wnioski: Służby ratownictwa medycznego w Europie nie są zobowiązane prawnie do wyposażenia swych zespołów w termometry przystosowane do pomiaru temperatury głębokiej ciała. Możliwości pełnej realizacji zaleceń ERC i prowadzenia optymalnego leczenia chorych w hipotermii głębokiej na etapie przedszpitalnym mogą być z tego powodu ograniczone.
Environmental Research, 2011
Introduction: Increases in mortality associated with oppressive weather have been widely investigated in several epidemiological studies. However, to properly understand the full public health significance of heat-related health effects, as well as to develop an effective surveillance system, it is also important to investigate the impact of stressful meteorological conditions on non-fatal events. The objective of our study was to evaluate the exposure-response relationship of ambulance dispatch data in association with biometeorological conditions using time series techniques similar to those used in previous studies on mortality. Methods: Daily data of emergency ambulance dispatches for people aged 35 or older in the summer periods from 2002 to 2006 were collected for the major towns in the Emilia-Romagna region. In the first stage of the analysis, the city-specific relationship between daily ambulance dispatches and increasing apparent temperature was explored using Generalized Additive Models while controlling for air pollution, seasonality, long-term trend, holidays and weekends. The relationship between ambulance dispatches and apparent temperature was approximated by linear splines. The effects of high temperatures on health were evaluated for respiratory and cardiovascular diseases as well as for all non-traumatic conditions. In the second stage of the analysis, city-specific effects were combined in fixed or random effect meta-analyses. Results: The percent change in the ambulance dispatches associated with every 1 1C increase in the mean apparent temperature between 25 and 30 1C was 1.45% (95% confidence interval: 0.95, 1.95) for non-traumatic diseases and 2.74% (95% CI: 1.34, 4.14) for respiratory diseases. The percent increase in risk was greater on days in which the mean apparent temperature exceeded 30 1C (8.85%, 95% CI: 7.12, 10.58 for non-traumatic diseases). In this interval of biometeorological conditions, cardiovascular diseases became positively associated with the apparent temperature. The risks increased with age. The increase in risk for the non-traumatic diseases reached 13.34% for people aged 75 or older compared to 4.75% for those aged 35-64. Conclusion: Time series analysis techniques were adopted for the first time to investigate emergency ambulance dispatches to evaluate the risks associated with biometeorological discomfort. Our findings show a strong relationship between biometeorological conditions and ambulance dispatches.