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Patients' experiences of cold exposure during ambulance care
Umeå University, Faculty of Medicine, Department of Nursing. (Arcum)
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Nursing. (Arcum)
2013 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, 44- p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2013. Vol. 21, 44- p.
Keyword [en]
Cold exposure, Comfort zone, Finger temperature, Thermal comfort, Thermal discomfort, Patients’ experience
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-81057DOI: 10.1186/1757-7241-21-44PubMedID: 23742143OAI: oai:DiVA.org:umu-81057DiVA: diva2:652541
Available from: 2013-10-01 Created: 2013-10-01 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Cold exposure and thermal comfort among patients in prehospital emergency care: innovation research in nursing
Open this publication in new window or tab >>Cold exposure and thermal comfort among patients in prehospital emergency care: innovation research in nursing
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Patients’ cold exposure is a neglected problem in prehospital emergency care. Cold stress increases pain and anxiety and contributes to fear and an overall sense of dissatisfaction. When left untreated, cold stress disturbs vital body functions until ultimately reaches hypothermia.

Aim

The overall aim was to investigate patients’ experiences of thermal comfort and reactions to cold exposure in prehospital emergency care and to evaluate the effects of an intervention using active warming from underneath.

Method

Study I:

Persons (n=20) injured in a cold environment in the north of Sweden were interviewed. Active heat was given to 13 of them.

Study II:

In wintertime, 62 patients were observed during prehospital emergency care. The field study was based on observations, questions about thermal discomfort, vital signs, and temperature measurements.

Study III:

Healthy young persons (n=23) participated in two trials each. Data were collected inside and outside a cold chamber. In one trial, the participants were lying on a regular ambulance stretcher and in a second trial on a stretcher supplied with a heated mattress. Outcomes were the Cold Discomfort Scale (CDS), back, finger, and core body temperature, four statements from the State-TraitAnxiety-Inventory (STAI), vital signs, and short notes about their experiences of the two stretchers.

Study IV:

A quantitative intervention study was conducted in prehospital emergency care in the north of Sweden. The patients (n=30) in the intervention group were transported in an ambulance supplemented with a heated mattress on the stretcher, whereas only a regular stretcher was used in the ambulance for the patients (n=30) in the control group. Outcomes were the CDS, finger, core body, and air temperature, and questions about cold experiences.

Results

Study I:

Patients suffered more because of the cold than from the pain of their injuries. The patients were in a desperate need of heat.

Study II:

Patients are exposed to cold stress due to cold environments. There was a significant decrease from the first measurement in finger temperature of patients who were indoors when the ambulance arrived, compared to the measurement taken in the ambulance. In the patient compartment of the ambulance, 85% of the patients had a finger temperature below the comfort zone and almost half of them experienced the patient compartment in the ambulance to be cold. The regular mattress surface temperature at the ambulance ranged from -22.3 to 8.4 ºC.

Study III:

A statistical increase of the participants’ back temperature was found between those lying on the heated mattress compared to those lying on the regular mattress. The heated mattress was experienced as warm, comfortable, providing security, and easy to relax on.

Study IV:

Thermal comfort increased for the patients in the intervention group and decreased in the control group. A significant higher proportion of the participants rated the stretcher as cold to lie on in the control group compared to the intervention group.

Conclusion

The ambulance milieu is too cold to provide thermal comfort. Heat supply from underneath increased comfort and might prevent cold stress and hypothermia

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2015. 50 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1718
Keyword
thermal comfort, thermal discomfort, cold exposure, cold stress, hypothermia, patients’ experiences, active warming, prehospital emergency care, finger temperature, back temperature
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-102599 (URN)978-91-7601-234-5 (ISBN)
Public defence
2015-05-22, Vårdvetarhuset, Aulan, Institutionen för omvårdnad, Umeå, 09:00 (English)
Opponent
Supervisors
Funder
Swedish National Board of Health and Welfare
Available from: 2015-04-30 Created: 2015-04-28 Last updated: 2016-06-30Bibliographically approved

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