CJEM Articles: ambulance

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  • Temporal artery thermometer use in the prehospital setting
    January 2012 14 1
    Ali Bell, Ashlee Mulligan, Brenda Fry, Cory Brossart, Erica Carleton

    Objectives:

    Prehospital vital signs are an important and required component of patient assessment. We compared the temporal artery thermometer (TAT) to the digital thermometer currently used in our emergency medical service (EMS) system and then to the digital thermometer used in the emergency department. The primary objective of this study was to assess the usefulness of the TAT in the prehospital setting. Other outcomes of interest included whether extraneous factors or cold ambient temperatures affected the TAT readings and paramedic satisfaction with the TAT.

    Methods:

    This was a prospective, observational study. Patient temperature was taken by EMS personnel with both the digital thermometer and the TAT, and a chart review was conducted on a sample of these patients to compare the TAT to the emergency department digital thermometer.

    Results:

    A total of 818 patients had their temperatures taken with both thermometers in the prehospital setting. The relationship between the TAT and digital thermometer measurement was positive and moderate; however, there was poor agreement between the two devices. Sixty-nine charts were reviewed, and a positive correlation was found between the TAT and the emergency department digital thermometer, with good agreement between the two devices. No extraneous factors were found to have a noticeable effect on the temperature measurements; the TAT performed well in cold weather, and the EMS personnel reported it to be easy to use.

    Conclusion:

    The TAT appears to be a suitable alternative to digital thermometers currently used in many EMS systems. The paramedics involved in this study liked the TAT better than the in-ambulance digital thermometer and believed it to be more accurate. Further research on this topic is required.

  • Evaluation of the Prehospital Index, presence of high-velocity impact and judgment of emergency medical technicians as criteria for trauma triage
    March 2010 12 2
    André Lavoie, Lynne Moore, Marcel Émond, Moishe Liberman, Stéphanie Camden

    Objective: We sought to evaluate the performance of the Prehos pital Index (PHI), the high velocity impact (HVI) criterion and emergency medical technician (EMT) judgment for the prehospital triage of injured patients.

    Methods: The study population included all prehospital trauma patients transported by an emergency medical service to 2 level I trauma centres for adults. All prehospital run sheets were linked to trauma registry data. The main outcome was severe trauma, defined as death within 72 hours, admission to the intensive care unit within 24 hours or an Injury Severity Score greater than 15. We assessed sensitivity, specificity and rates of overtriage.

    Results: Of 16 805 patients in the study population, 1113 (6.62%) had severe trauma. The combination of all 3 triage criteria (PHI score ≥ 4, HVI presence and EMT judgment) performed best for identifying patients with severe trauma, with a sensitivity of 74.2% but with an overtriage rate of 85.1%. Alone, EMT judgment had the highest sensitivity and a PHI score of 4 or greater had the low est rate of overtriage.

    Conclusion: Although the combination of PHI score, HVI pres ence and EMT judgment offers the highest sensitivity for the iden tification of patients that could benefit from direct transport to a level I trauma centre, overall sensitivity remains low and over triage is high. More research is required to improve prehospital triage.