How many paramedics dump ice on hyperthemic patients in the field?

DrParasite

DrParasite

The fire extinguisher is not just for show
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For the record, I've only seen this done once in the field

From
https://www.facebook.com/AustinTravisCountyEMS/posts/4316927558332188

Welcome to summer in Texas y’all!

Check out this story about a call Medic 3 ran yesterday.
#ATCEMSMedics from Medic 3 responded to a call for a patient with Altered Mentation. Upon arrival, Clinical Specialists K. Pailes & C. Shadden found the patient to be suffering from severe heat related illness: unable to answer questions or follow commands, with a rapid heart rate, and a core temperature of 107.2ºF.

The patient was treated with aggressive cooling measures, including full body immersion in an ice bath. Firefighters from Austin Fire Department Engine 11 were able to procure a large amount of ice & water from a nearby restaurant, and #ATCEMSMedics used a mega-mover (large tarp used to move patients) and an emergency blanket to contain the ice water around the patient. After approximately 10 minutes, the patient’s condition dramatically improved, he became awake & alert, his vital signs improved, and his core temperature dropped to 101ºF.

The patient was transported to Dell Seton Medical Center, and was discharged within a matter of hours.

While this was a great example of our clinicians thinking outside the box, we don’t want to meet you this way! Your #ATCEMSMedics would like to remind you to take heat safety seriously! As the temperatures continue to rise, please take them into consideration when planning your day. Wear sunscreen, stay hydrated, and take frequent breaks when participating in any outdoor activities.
 
Doesn’t get that hot where I’m at but I have seen this done once working a standby for a rave where we had a patient with suspected molly OD. Core body temperature of 107. Doctor ordered us to put the patient in this big bin of ice and once we got the temp down they flew him out.
 
I've never done it, but it's in our protocols. Our high schools are required to have ice baths available during outdoor fall and summer sports.
 
Do it all the time at work. Combination of chilled saline, cold water poured over them while in the back of the ambulance with a fan and AC on, also ice packs on groin, neck, and axillary. It works really well, with a rectal probe to monitor the temperature I’ve watched patients go from 107.6 down to 102 where we cease active cooling measures in a matter of minutes. The body still is cooling itself down after active measures stop so this way we don’t cause hypothermia.
 
That's what I would do if it were feasible, but it really doesn't get that hot in Colorado. It's available at the high school athletic facilities.
 
I’m interested, but I’d like to know the feasibility for departments with short transport times. If it hasn’t started before we got there, I’d have to think we’d be at the hospital before we had it all going.

The saline idea interests me too..
 
FiremanMike said:
I’m interested, but I’d like to know the feasibility for departments with short transport times. If it hasn’t started before we got there, I’d have to think we’d be at the hospital before we had it all going.

The saline idea interests me too..
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Time to hospital is not actually relevant. If it’s not started immediately more damage will occur. its one of the few conditions where stay and play is actually the better choice, when you have the appropriate tools. If all you got is ice packs then yes, rushing them to the emergency room would be appropriate. It’s entirely possible to get the patient stabilized before arriving at the hospital with this condition. A majority of the patients I transpor simply get labs, 12-lead, and a chest x-ray before being watched on the floor for 24hrs after they have been treated in the field. Except for a couple things that aren’t practical for being on a ambulance the treatment for a true heat emergency is entirely possible to be done in the back of the ambulance.
 
luke_31 said:
Time to hospital is not actually relevant. If it’s not started immediately more damage will occur. its one of the few conditions where stay and play is actually the better choice, when you have the appropriate tools. If all you got is ice packs then yes, rushing them to the emergency room would be appropriate. It’s entirely possible to get the patient stabilized before arriving at the hospital with this condition. A majority of the patients I transpor simply get labs, 12-lead, and a chest x-ray before being watched on the floor for 24hrs after they have been treated in the field. Except for a couple things that aren’t practical for being on a ambulance the treatment for a true heat emergency is entirely possible to be done in the back of the ambulance.
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But unless you have an ice maker on the truck or strategically placed ice reserves throughout your district, it is relevant. I wouldn’t be able to assemble a usable amount of ice to apply to the patient quicker than I could get them to the hospital..
 
FiremanMike said:
But unless you have an ice maker on the truck or strategically placed ice reserves throughout your district, it is relevant. I wouldn’t be able to assemble a usable amount of ice to apply to the patient quicker than I could get them to the hospital..
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Depends on where you are. In the municipalities where I operate, I could easily stop at a restaurant, convenience store or grocery to get ice and water, or send a fire fighter to fetch it. Putting the patient on a Reeves and filling it with ice and water will dramatically cool them. As everyone has been saying, this is one case where it's worth spending an extra 10 or 15 minutes on scene to actively cool the patient instead of just rushing to the ED.
 
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FiremanMike said:
But unless you have an ice maker on the truck or strategically placed ice reserves throughout your district, it is relevant. I wouldn’t be able to assemble a usable amount of ice to apply to the patient quicker than I could get them to the hospital..
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You would use a ice chest with either bottles of chilled water or ice sheets. A cooler will keep them chilled for about 18hrs easily in a cool truck.
 
NomadicMedic said:
Depends on where you are. In the municipalities where I operate, I could easily stop at a restaurant, convenience store or grocery to get ice and water, or send a fire fighter to fetch it. Putting the patient on a Reeves and filling it with ice and water will dramatically cool them. As everyone has been saying, this is one case where it's worth spending an extra 10 or 15 minutes on scene to actively cool the patient instead of just rushing to the ED.
Click to expand...
For me it’s all about the time stamp from time of contact until time of ice application. If that can be accomplished faster in the field then I’m all for it.

At least in my own department, I maintain some skepticism. This would be a single medic response, meaning unless the dispatcher was on it and starts the fire truck, then there’a the delay in getting them there, then the delay of thinking through who’s getting the ice and how, those folks leaving and returning, etc..

We are blessed to have a transport time of 5 mins or less in most parts of our district..

But, I’ll grant it could be possible with pre-planning starting from dispatching, involving local businesses, and solidifying the concept for our providers.

I do think Luke’s idea of the cooled water chest might be more realistic for us..

Lol I just realized we didn’t spec a fridge on the new medic for the first time in 10 years..
 
I’ve baths are not the current best practice. Evaporative cooling or temperature targeted therapy devices are preferred.

Patients who are cooled too quickly can begin to shiver. This not only can increase temperature but also can worsen electrolyte abnormality. Submersion cooling makes temperature monitoring essentially impossible as these patients should have a core temp monitored.

Caution should also be used with administration of cold IV fluids as there patients are at risk of heart failure and providing too much preload can very quickly exacerbate right sided failure making the patient more sick.

If you are going to use an ice pack you may find it much quicker and easier to maintain appropriate patient monitoring in the field by placing cold packs in the groin and axilla and/or turning up the AC blower after misting the patient with tepid water.
 
I had a horrible mess about 15 years ago. My very close friends wife called me to relay he had just arrived home and the maid said he was acting irrational. Wife called husband and tried to find out what was going on. She got out of him his refusing to go to the hospital and he wanted me to check on him.
A. I was about 100 miles away transporting another patient to a hospital.
B. Wife was bipolar and had a tendency to become hysterical under pressure.
C. Communication was spotty as I was driving through hilly country.
I told his wife to call an ambulance and don't take no for an answer. The best communication I was able to get across. Then about a half hour later the maids husband came in, checked my friend and I was relayed he was flushed and still somewhat incoherent. Then more broken communication. I finally got my patient to the hospital and got a land line. My friend had self diagnosed hyperthermia and was taking a cold shower on and off. Nobody had a thermometer. Taking a wild guess I prescribed icewater bath.
About 2 1/2 hours into the scenario I arrived at the house. Did an assess, got a temperature of 104, determined hyper. No ice. I sent him into the shower and ordered him to stay there. Around 3 hours he became coherent. Finally got some ice packs on him.

The problem was he was around 360-380 lbs and about 6'6" or so. Without the ice it was taking forever to get the core temperature down. He didn't return to normal until about 30 minutes with the ice packs around 4 hours into the episode. He had had several very bad experiences with ambulances in the past, the medics simply unable to move him, thus he had it in his head to never ride an ambulance again.
Added to that, the cold water at their house was probably around 70 degrees.
He recovered that night. We had to pack his wife to the hospital and have her sedated.
 
FiremanMike said:
For me it’s all about the time stamp from time of contact until time of ice application. If that can be accomplished faster in the field then I’m all for it.

At least in my own department, I maintain some skepticism. This would be a single medic response, meaning unless the dispatcher was on it and starts the fire truck, then there’a the delay in getting them there, then the delay of thinking through who’s getting the ice and how, those folks leaving and returning, etc..

We are blessed to have a transport time of 5 mins or less in most parts of our district..

But, I’ll grant it could be possible with pre-planning starting from dispatching, involving local businesses, and solidifying the concept for our providers.

I do think Luke’s idea of the cooled water chest might be more realistic for us..

Lol I just realized we didn’t spec a fridge on the new medic for the first time in 10 years..
Click to expand...
Surprised that's just a single medic response, seems like an altered patient (which heat stroke is) should be a high priority call no matter what the EMD system is.
 
Peak said:
I’ve baths are not the current best practice. Evaporative cooling or temperature targeted therapy devices are preferred.

Patients who are cooled too quickly can begin to shiver. This not only can increase temperature but also can worsen electrolyte abnormality. Submersion cooling makes temperature monitoring essentially impossible as these patients should have a core temp monitored.
Click to expand...
How do you suggest that gets done 45 minutes from the hospital? Also we are more than able to give fent and/or versed to assist in limiting shivering, much like what is done for TTM patients elsewhere.
 
Tigger said:
Surprised that's just a single medic response, seems like an altered patient (which heat stroke is) should be a high priority call no matter what the EMD system is.
Click to expand...

All depends on how probing the dispatcher is.. If the patient is altered, the dispatcher asks the right questions, and the caller understands, then it might get a full response, but generally this run would be dispatched as a "heat / cold exposure" and is a single medic response..
 
RedBlanketRunner said:
I had a horrible mess about 15 years ago. My very close friends wife called me to relay he had just arrived home and the maid said he was acting irrational. Wife called husband and tried to find out what was going on. She got out of him his refusing to go to the hospital and he wanted me to check on him.
A. I was about 100 miles away transporting another patient to a hospital.
B. Wife was bipolar and had a tendency to become hysterical under pressure.
C. Communication was spotty as I was driving through hilly country.
I told his wife to call an ambulance and don't take no for an answer. The best communication I was able to get across. Then about a half hour later the maids husband came in, checked my friend and I was relayed he was flushed and still somewhat incoherent. Then more broken communication. I finally got my patient to the hospital and got a land line. My friend had self diagnosed hyperthermia and was taking a cold shower on and off. Nobody had a thermometer. Taking a wild guess I prescribed icewater bath.
About 2 1/2 hours into the scenario I arrived at the house. Did an assess, got a temperature of 104, determined hyper. No ice. I sent him into the shower and ordered him to stay there. Around 3 hours he became coherent. Finally got some ice packs on him.

The problem was he was around 360-380 lbs and about 6'6" or so. Without the ice it was taking forever to get the core temperature down. He didn't return to normal until about 30 minutes with the ice packs around 4 hours into the episode. He had had several very bad experiences with ambulances in the past, the medics simply unable to move him, thus he had it in his head to never ride an ambulance again.
Added to that, the cold water at their house was probably around 70 degrees.
He recovered that night. We had to pack his wife to the hospital and have her sedated.
Click to expand...
20r82d.jpg
 
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