Patients’ experiences of cold exposure during ambulance care

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Britt-Inger Saveman¹  Stig Karlsson¹  Jonas Aléx¹ 

[1] Department of Nursing, Umea University, SE-901 87, Umea, Sweden

关键词: Patients’ experience;    Thermal discomfort;    Thermal comfort;    Finger temperature;    Comfort zone;    Cold exposure;   

Others  :  811046
DOI  :  10.1186/1757-7241-21-44

 received in 2013-03-15, accepted in 2013-06-01,  发布年份 2013

【 摘 要 】

Background

Exposure to cold temperatures is often a neglected problem in prehospital care. Cold exposure increase thermal discomfort and, if untreated causes disturbances of vital body functions until ultimately reaching hypothermia. It may also impair cognitive function, increase pain and contribute to fear and an overall sense of dissatisfaction. The aim of this study was to investigate injured and ill patients’ experiences of cold exposure and to identify related factors.

Method

During January to March 2011, 62 consecutively selected patients were observed when they were cared for by ambulance nursing staff in prehospital care in the north of Sweden. The field study was based on observations, questions about thermal discomfort and temperature measurements (mattress air and patients’ finger temperature). Based on the observation protocol the participants were divided into two groups, one group that stated it was cold in the patient compartment in the ambulance and another group that did not. Continuous variables were analyzed with independent sample t-test, paired sample t-test and dichotomous variables with cross tabulation.

Results

In the ambulance 85% of the patients had a finger temperature below comfort zone and 44% experienced the ambient temperature in the patient compartment in the ambulance to be cold. There was a significant decrease in finger temperature from the first measurement indoor compared to measurement in the ambulance. The mattress temperature at the ambulance ranged from −22.3°C to 8.4°C.

Conclusion

Cold exposure in winter time is common in prehospital care. Sick and injured patients immediately react to cold exposure with decreasing finger temperature and experience of discomfort from cold. Keeping the patient in the comfort zone is of great importance. Further studies are needed to increase knowledge which can be a base for implications in prehospital care for patients who probably already suffer for other reasons.

【 授权许可】

   
2013 Aléx et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Reed H, Reedy K, Palinkas L, Van Do N, Finney N, Case H, LeMar H, Wright J, Thomas J: Impairment in cognitive and exercise performance during prolonged Antarctic residence: effect of thyroxine supplementation in the polar triiodothyronine syndrome. J Clin Endocrinol Metab 2001, 86:110.
• [2]Bogoyavlenskiy D, Siggner A: Arctic demography. In Arctic Human Development Report (AHDR). Edited by Einarsson N, Nymand Larsen J, Nilsson A, Young OR. Akureyre: Artic Institure; 2004:27-41.
• [3]Olesen BW, Brager GS: A better way to predict comfort: The new ASHRAE standard 55-2004. ASHRAE J 2004, 46:20-28.
• [4]Havenith G, van de Linde EJG, Heus R: Pain, thermal sensation and cooling rates of hands while touching cold materials. Eur J Appl Physiol Occup Physiol 1992, 65:43-51.
• [5]Kregel KC, Seals DR, Callister R: Sympathetic nervous system activity during skin cooling in humans: relationship to stimulus intensity and pain sensation. J Physiol 1992, 454:359-371.
• [6]Tillman DB, Treede RD, Meyer RA, Campbell JN: Response of C fibre nociceptors in the anaesthetized monkey to heat stimuli: estimates of receptor depth and threshold. J Physiol 1995, 485:753-765.
• [7]Auliciems A, Szokolay SV: Passive and Low Energy Archtecture International (PLEA )in association with Department of Architecture. 2nd edition. Brisbane: University of Quensland; 2007. Designe tools and techniques, note 3
• [8]Pellerin N, Deschuyteneer A, Candas V: Local thermal unpleasantness and discomfort prediction in the vicinity of thermoneutrality. Eur J Appl Physiol 2004, 92:717-720.
• [9]Jay O, Havenith G: Finger skin cooling on contact with cold materials: a comparison between male and female responses during short-term exposures. Eur J Appl Physiol 2004, 91:373-381.
• [10]Candas V, Dufour A: Hand skin temperatures associated with local hand discomfort under whole-body cold exposure. J Hum Environ Syst 2007, 10:31-37.
• [11]Lan L, Lian Z, Liu W, Liu Y: Investigation of gender difference in thermal comfort for Chinese people. Eur J Appl Physiol 2008, 102:471-480.
• [12]Lintu NS, Mattila MAK, Holopainen JA, Koivunen M, Häninen OOP: Reactions to cold exposure emphasize the need for weather protection in prehospital care: an experimental study. Prehosp Disaster Med 2006, 21:316-321.
• [13]Lundgren P, Henriksson O, Widfeldt N, Wikström T: Insulated spine boards for prehospital trauma care in a cold environment. Int J Disaster Med 2004, 2:33-37.
• [14]Stocks JM, Taylor NA, Tipton MJ, Greenleaf JE: Human physiological responses to cold exposure. Aviat Space Environ Med 2004, 75:444-457.
• [15]Farley A, McLafferty E: Nursing management of the patient with hypothermia. Nurs Stand 2008, 22:43-46.
• [16]Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A: Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 1996, 347:289-292.
• [17]Peng RY, Bongard FS: Hypothermia in trauma patients. J Am Coll Surg 1999, 188:685.
• [18]Giesbrecht GG: Emergency treatment of hypothermia. Emerg Med 2001, 13:9-16.
• [19]Leslie K, Sessler DI, Bjorksten AR, Moayeri A: Mild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium. Anesth Analg 1995, 80:1007-1014.
• [20]Doufas AG: Consequences of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol 2003, 17:535-549.
• [21]Tsuei BJ, Kearney PA: Hypothermia in the trauma patient. Injury 2004, 35:7-15.
• [22]Valeri CR, MacGregor H, Cassidy G, Tinney R, Pompei F: Effects of temperature on bleeding time and clotting time in normal male and female volunteers. Crit Care Med 1995, 23:698-704.
• [23]Makinen TM, Palinkas LA, Reeves DL, Paakkonen T, Rintamaki H, Leppaluoto J, Hassi J: Effect of repeated exposures to cold on cognitive performance in humans. Physiol Behav 2006, 87:166-176.
• [24]Kurz A, Sessler DI, Lenhardt R: Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996, 334:1209-1216.
• [25]Kober A, Scheck T, Fulesdi B, Lieba F, Vlach W, Friedman A, Sessler DI: Effectiveness of resistive heating compared with passive warming in treating hypothermia associated with minor trauma: a randomized trial. Mayo Clin Proc 2001, 76:369-375.
• [26]Kurz A, Sessler DI, Birnbauer F, Illievich UM, Spiss CK: Thermoregulatory vasoconstriction impairs active core cooling. Anesthesiol 1995, 82:870.
• [27]Danzl DF, Pozos RS: Accidental hypothermia. N Engl J Med 1994, 331:1756-1760.
• [28]Henriksson O, Lundgren JP, Kuklane K, Holmér I, Bjornstig U: Protection against cold in prehospital care—thermal insulation properties of blankets and rescue bags in different wind conditions. wear 2009, 27:28.
• [29]Aléx J, Lundgren P, Henriksson O, Saveman BI: Being cold when injured in a cold environment–Patients’ experiences. Int Emerg Nurs 2013, 21:42-49.
• [30]Morse JM: Comfort. Clin Nurs Res 1992, 1:91-106.
• [31]Russo S, Timmermann A, Radke O, Kerren T, Bräuer A: Accidental hypothermia in the household environment. Importance of preclinical temperature measurement. Der Anaesthesist 2005, 54:1209.
• [32]Collins K: Low indoor temperatures and morbidity in the elderly. Age and Ageing 1986, 15:212-220.
• [33]Aitken LM, Hendrikz J, Dulhunty J, Rudd M: Hypothermia and associated outcomes in seriously injured trauma patients in a predominantly sub-tropical climate. Resuscitation 2009, 80:217-223.
• [34]Keim SM, Guisto JA, Sullivan JB Jr: Environmental thermal stress. Ann Agric Environ Med 2002, 9:1-15.
• [35]Verheyen J, Theys N, Allonsius L, Descamps F: Thermal comfort of patients: objective and subjective measurements in patient rooms of a Belgian healthcare facility. Build Environ 2011, 46:1195-1204.
• [36]Zhang H, Huizenga C, Arens E, Wang D: Thermal sensation and comfort in transient non-uniform thermal environments. Eur J Appl Physiol 2004, 92:728-733.
• [37]Giesbrecht GG, Wilkerson JA: Hypothermia, frostbite, and other cold injuries: prevention, survival, rescue and treatment. Seattle: The Mountaineers Books; 2006.
• [38]Lundgren JP, Henriksson O, Pretorius T, Cahill F, Bristow G, Chochinov A, Pretorius A, Bjornstig U, Giesbrecht GG: Field torso-warming modalities: a comparative study using a human model. Prehosp Emerg Care 2009, 13:371-378.
• [39]De Witte J, Sessler DI: Perioperative shivering: physiology and pharmacology. Anesthesiol 2002, 96:467-484.
• [40]Bergh U, Ekblom B: Influence of muscle temperature on maximal muscle strength and power output in human skeletal muscles. Acta Physiologica Scandinavica 1979, 107:33-37.
• [41]Scott E, Buckland R: A systematic review of intraoperative warming to prevent postoperative complications. AORN journal 2006, 83:1090.
• [42]Ji SH: Shifting of thermal comfort zone due to outdoor temperature. In Master thesis. Austin: University of Texas, Department in sustainable design; 2006.
• [43]Kingma B, Frijns A, van Marken Lichtenbelt W: The thermoneutral zone: implications for metabolic studies. Frontiers in Bioscience 1975, 2012:4.
• [44]Robinson S, Benton G: Warmed blankets: an intervention to promote comfort for elderly hospitalized patients. Geriatr Nurs 2002, 23:320-323.
• [45]Schlader ZJ, Simmons SE, Stannard SR, Mündel T: The independent roles of temperature and thermal perception in the control of human thermoregulatory behavior. Physiol Behav 2011, 103:217-224.
• [46]Wang D, Zhang H, Arens E, Huizenga C: Observations of upper-extremity skin temperature and corresponding overall-body thermal sensations and comfort. Build Environ 2007, 42:3933-3943.