title: A prospective evaluation of the contribution of ambient temperatures and transport times on infrared thermometry readings of intravenous fluids utilized in EMS patients.
abstract: BACKGROUND
  During cold weather months in much of the country, the temperatures in which prehospital care is delivered creates the potential for inadvertently cool intravenous fluids to be administered to patients during their transport and care by emergency medical services (EMS). There is some potential for patient harm from unintentional infusion of cool intravenous fluids. Prehospital providers in these cold weather environments are likely using fluids that are well below room temperature when prehospital intravenous fluid (IVF) warming techniques are not being employed. It was hypothesized that cold ambient temperatures during winter months in the study location would lead to the inadvertent infusion of cold intravenous fluids during prehospital patient care.
  
  
  METHODS
  Trained student research assistants obtained three sequential temperature measurements using an infrared thermometer in a convenience sample of intravenous fluid bags connected to patients arriving via EMS during two consecutive winter seasons (2011 to 2013) at our receiving hospital in Syracuse, New York. Intravenous fluids contained in anything other than a standard polyvinyl chloride bag were not measured and were not included in the study. Outdoor temperature was collected by referencing National Weather Service online data at the time of arrival. Official transport times from the scene to the emergency department (ED) and other demographic data was collected from the EMS provider or their patient care record at the time of EMS interaction.
  
  
  RESULTS
  Twenty-three intravenous fluid bag temperatures were collected and analyzed. Outdoor temperature was significantly related to the temperature of the intravenous fluid being administered, b = 0.69, t(21) = 4.3, p < 0.001. Transport time did not predict the measured intravenous fluid temperatures, b = 0.12, t(20) = 0.55, p < 0.6.
  
  
  CONCLUSIONS
  Use of unwarmed intravenous fluid in the prehospital environment during times of cold ambient temperatures can lead to the infusion of cool intravenous fluid and may result in harm to patients. Short transport times do not limit this risk. Emergency departments should not rely on EMS agencies' use of intravenous fluid warming techniques and should consider replacing EMS intravenous fluids upon ED arrival to ensure patient safety.
authors.affiliation: Department of Emergency Medicine, State University of New York Upstate Medical University, Syracuse, NY 13210 USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Joslin
authors.affiliation: State University of New York Upstate Medical University, Syracuse, NY 13210 USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fisher
authors.affiliation: Department of Emergency Medicine, State University of New York Upstate Medical University, Syracuse, NY 13210 USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Wojcik
authors.affiliation: Department of Emergency Medicine, State University of New York Upstate Medical University, Syracuse, NY 13210 USA ; EMSTAT Center, 550 East Genesee St., Syracuse, NY 13202 USA.
authors.forename: Derek R
authors.initials: DR
authors.lastname: Cooney
keywords: Ambulance; Emergency department; Emergency medical services; Environmental medicine; Fluid; Hypothermia; Intravenous; Saline; Temperature