Does anyone carry a thermometer on their bus?

[Tigger]

Temperature is a vital sign, is it not? It might not be for EMS, but it is in the rest of healthcare. Even working on a straight BLS truck I'd like a thermometer so I can give the temp as part of my report.

Bigger hospitals that have ambulance triage probably have "communal" thermometers, but when you roll into a small (or big I suppose) ER where the patient goes straight to the room it seems like passing along the fact that the patient has a fever might be good.

I'm also tired of taking clear UTI patients into ERs and having someone asking for his temp and being forced to sheepishly respond "a little warm."

 

[rmabrey]

We have them. Do we use them? No. It's a pain to get them out of the drug box, if you even have one, temperature doesn't change treatment. The ER will check anyway.

Sent from my Desire HD using Tapatalk

 

[Hellsbells]

It's why things are so ed up right now. "Wow...we can do this in the field and it'll make our job so much easier! But we won't teach anybody about it, after all it's so simple we don't need to! And even better, we can stop teaching them about something else because of this new thing!"

For patien'ts like the one you talked about, there have been things in their history and exam that made me lean towards pneumonia instead of CHF. And I'm a ing average paramedic; if I can figure this out then anyone should be able to.

So, to be clear, you argue that Thermometers should not be placed on the ambulance because practitoners can not or will not be trained to use them? Yet, on the other hand any middling paramedic can tell the difference between CHF and pneumonia without the aforementioned tool?

We have them. Do we use them? No. It's a pain to get them out of the drug box, if you even have one, temperature doesn't change treatment. The ER will check anyway.

Thank you great sage, for finally settling this argument.

 

[triemal04]

So, to be clear, you argue that Thermometers should not be placed on the ambulance because practitoners can not or will not be trained to use them? Yet, on the other hand any middling paramedic can tell the difference between CHF and pneumonia without the aforementioned tool?

No, I don't think a thermometer should be placed on an ambulance until every provider is capable of using the tools that are allready available to them. That includes the ability to take a good history, perform a good physical exam, take in the entire situation and then process that information.

I think a large part of why things are so screwy down here is illustrated by this whole arguement, and I said it in my last post. Instead of teaching people how to think they're being given a tool that acts as a crutch, and can be, and often will be, misused.

Yes, even something as simple as a thermometer. If the basic knowledge and abilities aren't there, it can screw things up. I can talk about the patient's that I've seen brought into the ER who were treated completely innapropriately by the ambulance crew because they found a fever and decided that was the real issue. It does happen.

Why not learn to work with what is there first, and then add more tools as they become needed?

As an aside, I thought I was clear about this; in the vast majority of cases, if a thorough history/physical is done and someone with half a brain thinks about it, knowing a specific numeric value for someone's temperature should not be what makes or breaks their diagnosis. Now, I'm not going to pretend that is the case nationally right now; I know there is a ways to go before we get there as a whole. But why not look at it like that? Everybody always talks about adding to the paramedic scope and abilities, but seems to forget that many right now can't even do the basics appropriately.

It's how we got in this situation in the first place.

 

[triemal04]

I meant collective "you," not you personally.

To answer your question honestly, aside from the history and suspicion of new onset, temperature was all I had to defeat the cookbook. So I went with it.

If it makes you feel better, I use serial temperatures on my daughter when she gets sick to decide if I will give her something or not.

I know when she is sick without the temp. But I guess you could say it guides my decision. But I give it a +/-1

Be more specific if you can, I'm honestly curious about this. Looking back, do you think that, knowing what you do now, if you were to examine that same patient using the same physical resources you had then but your current knowledge, that you wouldn't be able to find/illicit something in either the history or exam that would point towards pneumonia?

The last line is part of what I've been trying to say. You should allready have an idea of what is going on without checking. It can help with figuring out what the problem is, but shouldn't be the only thing.

 

[Veneficus]

Be more specific if you can, I'm honestly curious about this. Looking back, do you think that, knowing what you do now, if you were to examine that same patient using the same physical resources you had then but your current knowledge, that you wouldn't be able to find/illicit something in either the history or exam that would point towards pneumonia?

KNowing what I know now, I am fairly certain I could have elicited a historical response and my ability to listen to and differentiate lung sounds is much better now than as a paramedic. I could also use percussion as a useful tool.

As a new paramedic I did not have such insights. I admit, I needed the crutch.

Having said that however, as I mentioned in my n=1 anecdote, without the quantatative number, I would have been hard pressed to convince the FTO otherwise, even with the knowledge I have today.

If having paramedics take a temperature stops somebody from following through a line item cookbook, then as far as I am concerned they are worth exponentially more than they cost.

The last line is part of what I've been trying to say. You should allready have an idea of what is going on without checking. It can help with figuring out what the problem is, but shouldn't be the only thing.

I had an idea what might be going on then. But I had no way to convince somebody else.

Would a doctor take into account such suspicion. I think so. BUt we have to be realistic about something that has gone on in EMS for ages.

The new people coming out of school have better/more up to date education than many of the older people. (the same is true in medicine)

However, the pseudocommand structure in most of EMS in the US does not permit the same discussion before forming treatment modalities that a junior doctor speaking to a senior doctor does.

As much as I would like to see it, I don't think it is really realistic in the US to put somebody with my education on an ambulance though.

In order to match that, you are talking about more than a decade of experience and education combined with 6 years of graduate medical and concentrated pathophysiology education.

You can't get paramedics to a minimum of an associates degree.

How could you possibly compare the proficency of a new medic (me or otherwise) to a rather extensively educated and experienced provider? (forget things like talent and intellect, stick with the measurable things)

I have spent more hours researching "small" topics like aneurysm and AKI for my pathophysiology requirements(4/6 months respectively, 6-8 hours 6 days a week, averaged out to 1680 hours for those 2 topics) than most paramedics have total hours in class in their whole education.

It also gives me considerably more insight than my peers who only study medicine.

Sorry to say, but paramedics are going to need some crutches until at least a 4 year degree is mandatory and probably even then.

 

[Hellsbells]

The last line is part of what I've been trying to say. You should allready have an idea of what is going on without checking. It can help with figuring out what the problem is, but shouldn't be the only thing.

Personally, I don't think a thermometer is a magic wand, to be waved over a patient, resulting in an ironclad Dx, as you say its just one part of a larger picture. Why do you think basics or Paramedics can't be taught how to use this tool. In my experience, when new equipment is put on the unit, we get an appropriate inservice on how it works.

I'll admit, I don't work in the US, but personally I can't see the addition of a thermometer on the unit being such a timebomb, it results in misery, blown assessments and lazy Hx by all who touch it.

triemal04, I'll ask you, what would it take to convince you a practitioner was properly trained to use this tool?

 

[triemal04]

Personally, I don't think a thermometer is a magic wand, to be waved over a patient, resulting in an ironclad Dx, as you say its just one part of a larger picture. Why do you think basics or Paramedics can't be taught how to use this tool. In my experience, when new equipment is put on the unit, we get an appropriate inservice on how it works.

I'll admit, I don't work in the US, but personally I can't see the addition of a thermometer on the unit being such a timebomb, it results in misery, blown assessments and lazy Hx by all who touch it.

triemal04, I'll ask you, what would it take to convince you a practitioner was properly trained to use this tool?

I do think that paramedics, EMT's, or even a random person off the street could be taught how to use a thermometer and appropriately interpret what they find in connection with everything else they have seen/heard/found/touched/etc/etc. I think that paramedics should be taught how to do that.

That is the problem though.

I've come across probably stronger than neccasary on this, but this is a nice microcosm of where EMS in the US is at. To answer your question, once someone can take an appropriate oral history, perform a thourough physical exam, understand how a patien'ts surroundings fit in, interpret a medication list, understand some basic medical concepts and understand some basic pathophysiology and know about diseases (you get the point I'm sure so I'll stop), fit all that information together and come up with a pretty good idea of what is going on without more than a few simple tools (or not so simple in some cases), then there wouldn't be any reason not to have that, or many other things available to them.

But until they can understand all that, adding a new piece of information may do nothing more than confuse someone.

If you want to skip all that, basically until someone can come up with as accurate a diagnosis as possible without something, and be able to interpet a new finding without getting confused, nothing else should be added.

It's not that this is a "timebomb," though I flat out gaurentee that it would cause many people to treat/not treat patient's innapapropriately. It's only been what I've seen, though I'm sure you'd find many similar stories if you polled ER personell, but I can give you several examples. Like I said earlier, it's just another example of how things got so screwy down here.

 

[triemal04]

KNowing what I know now, I am fairly certain I could have elicited a historical response and my ability to listen to and differentiate lung sounds is much better now than as a paramedic. I could also use percussion as a useful tool.

As a new paramedic I did not have such insights. I admit, I needed the crutch.

Having said that however, as I mentioned in my n=1 anecdote, without the quantatative number, I would have been hard pressed to convince the FTO otherwise, even with the knowledge I have today.

If having paramedics take a temperature stops somebody from following through a line item cookbook, then as far as I am concerned they are worth exponentially more than they cost.

Sure. And I'm not suggesting that paramedic's need to be educated to the MD level; just that if more time was spent on assessment skills and overall knowledge that it would be a better idea and have better overall results than filling the knowledge gap with equipment.

I had an idea what might be going on then. But I had no way to convince somebody else.

Would a doctor take into account such suspicion. I think so. BUt we have to be realistic about something that has gone on in EMS for ages.

The new people coming out of school have better/more up to date education than many of the older people. (the same is true in medicine)

However, the pseudocommand structure in most of EMS in the US does not permit the same discussion before forming treatment modalities that a junior doctor speaking to a senior doctor does.

That can definetly be a problem. There's always people out there who can literally have the solution staring them in the fact and not see it.

I still stand by the point that, unless you truly understand how to function without something to the best of your ability, and then get properly taught how to use, and intergrate a new tool into you assessment, you should not be using it. And if that tool is used as a crutch to make up for that lack of education, that is the time when you are more likely to find people misusing it.

In your example, you found a fever, though potentially you also could have determined it was pneumonia another way. In my examples, people have found a mildly elevated temp and decided that the acute bronchospasm from the patient's longstanding COPD was pneumonia and didn't need treatement. Or the near-classic cardiac chest pain in patient's with and without distubring histories was pain from pneumonia because they found a fever.

Without knowing how to use it, and having the background to use it, it can go both ways.

As much as I would like to see it, I don't think it is really realistic in the US to put somebody with my education on an ambulance though.

In order to match that, you are talking about more than a decade of experience and education combined with 6 years of graduate medical and concentrated pathophysiology education.

You can't get paramedics to a minimum of an associates degree.

How could you possibly compare the proficency of a new medic (me or otherwise) to a rather extensively educated and experienced provider? (forget things like talent and intellect, stick with the measurable things)

Again, that wasn't what I was suggesting. Simply that until people can work with what they allready commonly use (in the US) and perform some basic things, there is no point in adding more. If you did would it help in some cases? Sure, but it would also cause problems in some cases.

I have spent more hours researching "small" topics like aneurysm and AKI for my pathophysiology requirements(4/6 months respectively, 6-8 hours 6 days a week, averaged out to 1680 hours for those 2 topics) than most paramedics have total hours in class in their whole education.

It also gives me considerably more insight than my peers who only study medicine.

Sorry to say, but paramedics are going to need some crutches until at least a 4 year degree is mandatory and probably even then.

That is unfortunately the type of thinking that has gotten the EMS system here so screwed up. Not pointing fingers, but it really is. Instead of trying to fix things, bandaids are just thrown on the problem which only makes things worse. In some cases the bandaids may work, but on a national level, looking at everyone concerned, they really don't.

 

[EMS123]

Have an ear thermomete in each rig... used mostly for peds even though not in NYS BLS Protocols.

 

[MasterIntubator]

Original question: Yes. 3 of them. Oral/Ax, Rectal, temporal thermometers. And use them regularly.