A prospective evaluation of the contribution of ambient temperatures and transport times on infrared thermometry readings of intravenous fluids utilized in EMS patients.

Jeremy Joslin,Andrew Fisher,Derek R Cooney,Susan Wojcik

doi:10.1186/s12245-014-0047-y

Jeremy Joslin, Andrew Fisher + Show 2 more

Open Access

https://doi.org/10.1186/s12245-014-0047-y

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Abstract

BackgroundDuring cold weather months in much of the country, the temperatures in which prehospital care is delivered creates the potential for inadvertently cool intravenous fluids to be administered to patients during their transport and care by emergency medical services (EMS). There is some potential for patient harm from unintentional infusion of cool intravenous fluids. Prehospital providers in these cold weather environments are likely using fluids that are well below room temperature when prehospital intravenous fluid (IVF) warming techniques are not being employed. It was hypothesized that cold ambient temperatures during winter months in the study location would lead to the inadvertent infusion of cold intravenous fluids during prehospital patient care.MethodsTrained student research assistants obtained three sequential temperature measurements using an infrared thermometer in a convenience sample of intravenous fluid bags connected to patients arriving via EMS during two consecutive winter seasons (2011 to 2013) at our receiving hospital in Syracuse, New York. Intravenous fluids contained in anything other than a standard polyvinyl chloride bag were not measured and were not included in the study. Outdoor temperature was collected by referencing National Weather Service online data at the time of arrival. Official transport times from the scene to the emergency department (ED) and other demographic data was collected from the EMS provider or their patient care record at the time of EMS interaction.ResultsTwenty-three intravenous fluid bag temperatures were collected and analyzed. Outdoor temperature was significantly related to the temperature of the intravenous fluid being administered, b = 0.69, t(21) = 4.3, p < 0.001. Transport time did not predict the measured intravenous fluid temperatures, b = 0.12, t(20) = 0.55, p < 0.6.ConclusionsUse of unwarmed intravenous fluid in the prehospital environment during times of cold ambient temperatures can lead to the infusion of cool intravenous fluid and may result in harm to patients. Short transport times do not limit this risk. Emergency departments should not rely on EMS agencies’ use of intravenous fluid warming techniques and should consider replacing EMS intravenous fluids upon ED arrival to ensure patient safety.

Highlights

During cold weather months in much of the country, the temperatures in which prehospital care is delivered creates the potential for inadvertently cool intravenous fluids to be administered to patients during their transport and care by emergency medical services (EMS)
Gentilello has equated the effect of unwarmed intravenous fluids (IVFs) on body temperature to that of a patient who must use 16 kcal of energy to warm a liter of room temperature (21°C) crystalloid to 37°C
The outdoor temperature measured significantly predicted the temperature of the IVF being administered, b = 0.69, t(21) = 4.3, p < 0.001

Summary

Introduction

During cold weather months in much of the country, the temperatures in which prehospital care is delivered creates the potential for inadvertently cool intravenous fluids to be administered to patients during their transport and care by emergency medical services (EMS). The United States National Oceanic and Atmospheric Administration (NOAA) National Climatic Data Center reports with 90% probability that our receiving hospital located in Syracuse, New York (NY) experiences a temperature at or below freezing 215 days per year and more generalizable, the entire Northeast, most of the Midwest, and the Great Plains north of Nebraska all experience similar temperature patterns with regard to number of days below freezing [1] This preponderance of cold temperatures in which prehospital care is delivered creates the potential for cool intravenous (IV) fluids to be administered to patients during their transport and care. While prospective data conflict on the relationship between mortality and the presence of hypothermia in trauma patients, complications associated with hypothermia and morbidity have been associated [3,4]

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