Temperature

[PapaBear434]

Wow, I hit a nerve there. I'm not disagreeing with you guys that it's a vital, and pretty damn important. However, as a guy who just got out of training a couple of weeks ago, the new standard says your vitals are pupils, BP, pulse, skin (this included temperature), and respirations. Hell, even lung sounds aren't considered a vital, but instead a step in assessment of the lungs only.

Maybe it's just a Virginia thing, but that's the way it is. BLS is little more than tow truck drivers, hauling the cars (patients) to the mechanic (hospital), hopefully without causing any more damage than when we initially picked them up with. They keep us pretty limited. In fact, over half of the jurisdictions don't even allow anything under Paramedic level place an advanced airway, under the idea that EMT-I and below wouldn't do it enough to maintain a high enough proficiency.

I know, as it's obvious, that temperature is important. But as far as the training is concerned, taking an exact temperature is going the extra mile, not standard care.

 

[firecoins]

We aren't allowed to check for core temp through a rectal temp where we work. So we are stuck using inaccurate methods if we have those tools available. We usually don't. I guess we will be stuck treating the patient via MOI/NOI, chief complaints and obvious signs of fever, cold or heat injuries. It works for now.

 

[mikeylikesit]

We aren't allowed to check for core temp through a rectal temp where we work. So we are stuck using inaccurate methods if we have those tools available.

don't worry....you wont find too many volunteers for that anyways...or for practice for that matter.

 

[firecoins]

don't worry....you wont find too many volunteers for that anyways...or for practice for that matter.

I am not too worried.

 

[Ridryder911]

That's just it: Temperature isn't considered a vital for BLS. We deal in immediate and obvious life threats. Are they abnormally hot or cold? That's good enough for our purposes. Anything more involved is going to need an ALS intervention to fix anyway.

All I can say is wow!.. I'll let the BLS providers speak..

R/r 911

 

[BossyCow]

Wow, I hit a nerve there. I'm not disagreeing with you guys that it's a vital, and pretty damn important. However, as a guy who just got out of training a couple of weeks ago, the new standard says your vitals are pupils, BP, pulse, skin (this included temperature), and respirations. Hell, even lung sounds aren't considered a vital, but instead a step in assessment of the lungs only.

I'm confused. You say that temp is included with skin but not a vital? Sounds like it is to me. If temp is included, it should be taken and taken accurately.

Maybe it's just a Virginia thing, but that's the way it is. BLS is little more than tow truck drivers, hauling the cars (patients) to the mechanic (hospital), hopefully without causing any more damage than when we initially picked them up with. They keep us pretty limited. In fact, over half of the jurisdictions don't even allow anything under Paramedic level place an advanced airway, under the idea that EMT-I and below wouldn't do it enough to maintain a high enough proficiency

There is a huge difference between placing an ET tube and taking a temp. Surely you are not suggesting that taking an accurate temp is an ALS skill. Now, if you believe that your state's standards are low, you can either sink to that standard or rise above them. Your standard of care and your dedication to your skill set needs to be a personal thing, not state mandated. Sure the state will say you can't do some skills without proper education and training, but how well you do patient care within your scope is up to you.

I know, as it's obvious, that temperature is important. But as far as the training is concerned, taking an exact temperature is going the extra mile, not standard care.

Darlin'... let me say this about that... GOING THE EXTRA MILE IS STANDARD CARE!

 

[PapaBear434]

I'm confused. You say that temp is included with skin but not a vital? Sounds like it is to me. If temp is included, it should be taken and taken accurately.


There is a huge difference between placing an ET tube and taking a temp. Surely you are not suggesting that taking an accurate temp is an ALS skill. Now, if you believe that your state's standards are low, you can either sink to that standard or rise above them. Your standard of care and your dedication to your skill set needs to be a personal thing, not state mandated. Sure the state will say you can't do some skills without proper education and training, but how well you do patient care within your scope is up to you.



Darlin'... let me say this about that... GOING THE EXTRA MILE IS STANDARD CARE!

You misunderstand. Skin temp is just using the back of the hand to feel the skin. Is it hot or cool, dry or moist. That's IT.

I am not equating an ET tube with temperature taking. I used that as an example of how much VAEMS likes to hobble their providers under the assumption that in most places a hospital is within less than fifteen minute driving distance.

I won't deny that going the extra mile isn't what we should all strive for. What I said is that as far as the training goes, feeling the skin is "good enough" for us.

You guys are confusing my arguments with that of the training I received. Don't kill the proverbial messenger.

 

[Airwaygoddess]

Patient care.........

Checking a patient's temperature should be part of the vital signs for BLS and ALS calls. This is would be considered part of the patient's assessment. First and foremost, the ABC's should be checked, any problems corrected, and continue with on going care.

With the continuing rise of patients that are discharged from the hospital after having invasive tests and or procedures done, anywhere from 8 to 48 hours post procedure is alarming. Gone are the days for a patient that would have had a "standard" surgical procedure, stay in the hospital for a minimum of 3-4 days, received bedside care and monitoring. At this point, if the patient had any surgical drains, they would have been removed by the doctor. Discharge teaching would have been done by the nursing staff and the patient would have been discharged home.

Patients are being discharged home sooner with surgical drains, foley catheters, intravenous devices and feeding tubes. What needs to be remembered that these devices are a common route for sepsis to occur, with patient's immune system is already compromised, age and disease process also contribute greatly to this condition.

Many hospitals across the United States are implementing a sepsis protocol that starts in the emergency department when the patient arrives. I strongly believe that by checking a patient's temperature in the field with baseline vital signs and with the ongoing assessment, will contribute to the continuum of care that is much needed for the best patient outcome. I also think that a sepsis protocol should be developed and implemented for pre hospital care, this in turn would be beneficial for the continuum of patient care.

Environmental emergencies would also call for the monitoring of a patients temperature. Once again this should also be a standard part of the patient's vital signs and ongoing assessment and treatment, after the ABC's have been assessed and corrected as needed. If the patient's condition requires a core temperature, then it is important to be to preform this function with the proper training and professionalism that is required for our job. I, at times grow very tired of the "rectal jokes" and the "that gross!" attitude. Gross is when you run a child or elder abuse call, and see what another human being has done to a helpless soul. Gross is arriving on scene to a pediatric drowning and seeing the firefighters trying to get a pulse back on a 2 year old with a unknown down time, and the parents saying, "I only looked away for just a minute!"

It is our professional obligation and positive attitude that requires us provide the best pre hospital care possible to the public through education, training and quality improvement, to set a strong example for the for up and coming and brand new pre hospital care providers. The bottom line is this, we are the patient's advocate in the field, we give that patient a fighting chance....
Respectfully submitted.....-_-

 

[mikeylikesit]

If they feel hot...cool them down. If they feel cool, heat them up. if they are wet dry them off. If they are dehydrated moisten them up (get your mind out of the gutter) it is not so hard right? (Mild sarcasm.)

 

[VentMedic]

If they feel hot...cool them down. If they feel cool, heat them up. if they are wet dry them off. If they are dehydrated moisten them up (get your mind out of the gutter) it is not so hard right? (Mild sarcasm.)

That is not always true.

Many people with sepsis will feel cool and almost cold to touch while their core temp is 104. EMTs and Paramedics have actually argued with RNs at nursing homes "they don't feel hot to me, what make you think they have a fever?". They took a rectal temp, that's how. I hear these same uneducated remarks in the ED. The Paramedics actually think they have made some statement about the NH's stupidity when all they did was lose credibility in the ED.

 

[BossyCow]

You misunderstand. Skin temp is just using the back of the hand to feel the skin. Is it hot or cool, dry or moist. That's IT.

I don't 'misunderstand' I disagree. Using the back of the hand to check a temp assumes that your hand is an accurate measure of temp. If your hands are cold, the pt will feel warmer than they actually are or if your hands are warm, the pt will feel cooler than in actuality. Using a hand to aproximate skin temp is not taking a vital, nor should be be. Checking that way, is part of assessment but not a vital. A vital is a temp and is done with a thermometer.

I am not equating an ET tube with temperature taking. I used that as an example of how much VAEMS likes to hobble their providers under the assumption that in most places a hospital is within less than fifteen minute driving distance.

Insisting that a provider have the training to support an invasive skill is not 'hobbling' but is being responsible. You bring this up in support of your argument but I can't see its relevance to the temperature taking.

I won't deny that going the extra mile isn't what we should all strive for. What I said is that as far as the training goes, feeling the skin is "good enough" for us.

I'm confused, are you saying that feeling the skin is all you were taught to do, all you are allowed to do, or all you feel you should do? Temperature is a vital sign. Period. If you are supposed to take vitals, then you should take all of them and take them accurately. If you are more than 15 minutes from a hospital, you have the time, do the temp. (Our average transport is 20+ minutes)

You guys are confusing my arguments with that of the training I received. Don't kill the proverbial messenger.

Well, our confusion is in response to your post. Your initial post sounded like.."Hey, my system sucks and doesn't care, so why should I do more than the minimum"

 

[Ridryder911]

the new standard says your vitals are pupils, BP, pulse, skin (this included temperature), and respirations.

When did pupils become a vital sign? Many medical schools are not even teaching to check pupils such as in PEARL anymore. Do you really know what it means when they are not.. (No I don't mean head injury) ? Is it normal to have unequal pupils, or if they are sluggish or lack accommodation? When there is so much better and more detailed neurological evaluations out there. Heck, pupils should only be checked in secondary examination, not even included in a primary evaluation.

Vital signs have always been and will always be:

Temperature
Pulse
Respiration's
Blood Pressure

That is the essentials, anything more is just that additional information important yes but not considered vital signs. Vital Signs are regarded as the most important signs representing the patients condition. If you were taught other than that, they were wrong.. period.

R/r 811

 

[mikeylikesit]

That is not always true.

Many people with sepsis will feel cool and almost cold to touch while their core temp is 104. EMTs and Paramedics have actually argued with RNs at nursing homes "they don't feel hot to me, what make you think they have a fever?". They took a rectal temp, that's how. I hear these same uneducated remarks in the ED. The Paramedics actually think they have made some statement about the NH's stupidity when all they did was lose credibility in the ED.

....hence the last two words of my post. "Mild Sarcasm"
i'm not an idiot i do have a lot of training in medical far beyond that of a paramedic. but for a basic these "should be good guidelines" to follow based on enviormental factors that they can see and feel...not every situation that they may encounter.

 

[PapaBear434]

I don't think there is any way for me to get this across. I agree with you guys. I take temp any time I am able. But our protocols say pupils, respirations, BP, pulse, and skin (general term) are our vitals. It even has those five designated in our PCR. Temperature is only allowed a spot on the ALS PCR sheets.

I can't stress this enough: I AGREE WITH YOU GUYS. I am just saying that either training has changed, or training standards have severely slackened.

 

[Ridryder911]

I don't think there is any way for me to get this across. I agree with you guys. I take temp any time I am able. But our protocols say pupils, respirations, BP, pulse, and skin (general term) are our vitals. It even has those five designated in our PCR. Temperature is only allowed a spot on the ALS PCR sheets.

I can't stress this enough: I AGREE WITH YOU GUYS. I am just saying that either training has changed, or training standards have severely slackened.

No problem, with you.. Just your protocols and education criteria needs to be on track...

R/r 911