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Ultimately, fever should be considered in the context of the bigger
clinical picture and, in isolation, may have less relevance in children
compared to adults, at least in the prehospital setting.
As eluded to earlier, there are distinct variations in a patient’s measured temperature, depending on where and how the temperature is
measured. The ideal measurement of temperature in the human body
is to measure the body’s core temperature.
In the operating room with an anesthetized patient, this is ideally
measured with an esophageal probe; however, this isn’t practical in
the field. Rectal temperature measurements are also very close to core
temperature but again, aren’t practical in the field.
This leaves us with four possible modalities: 1) electronic sublingual and/or rectal; 2) temporal artery scan; 3) distant infrared scan; and
4) infrared tympanic measurement. (See Table 3, p. 36.)
Relatively inexpensive and common, electronic thermometers with
disposable probes for sublingual or rectal use are very reliable for field
use, especially during transport.
Temporal artery scan thermometers can be substantially influenced
and invalidated by sweat and/or moisture, so they’re not reliable for
field use, especially with a diaphoretic patient.
Distant infrared scan thermometers are very inexpensive, and completely noninvasive, but only measure the temperature at the skin surface, which can be substantially lowered in many physiological and
environmental conditions, making it less than desirable for diagnostic purposes.
Out of the four technologies, the two which come closest to accurately measuring the patient’s core temperature, are the high-quality
electronic oral thermometers described earlier and infrared tympanic
measurement temperature monitors, which are relatively inexpensive,
reliable, not overly intrusive and efficient.
The intent of this article is to present important and often neglected
facts to EMS providers, educators, medical directors and managers.
First, we’re only as good clinically as the data we acquire and the
way we piece it together and recognize deviations and combinations
that can be dangerous to our patients.
Second, temperature is an important vital sign. Although this is recognized throughout EMS textbooks and medicine it has been passed
over too often by EMS agencies throughout the past several years.
If we’re going to be successful in treating and transporting our
patients to a higher level of care, we must be diligent in acquiring and
recording all of the data possible.
The initial presentation of a patient can determine how that patient
will be managed until definitive diagnostic procedures can be performed and the additional data analyzed. In conjunction with blood
pressure, heart rate, respirations and oxygen saturation, temperature
completes the clinical picture of our patient in the field, and its role
and importance can’t be underestimated. JEMS
Joseph E. DiCorpo, BSc, MMSc, PA, is an air ambulance and international medical consultant based in Atlanta. He’s practiced anesthesiology, critical care medicine and emergency medicine. He started as an EMT in 1971 and was an EMS chief and administrator in
Ohio and California.
Matthe w Harris, MD, is a pediatric emergency medical attending physician at Cohen Children’s Hospital Center in New Hyde Park, N. Y. He’s dual-trained in EMS and disaster medicine and is on the faculty of the EMS Fellowship Program of Northern New Jersey. He also
serves as a tactical physician for the New Jersey State Police S WAT Team.
Mark Merlin, DO, EMT-P, FACEP, is the system medical director of MONOC EMS, New Jer-
sey’s largest EMS system. He’s an associate professor at Rutgers School of Public Health and
Medical School. He’s vice-chairman of emergency medicine and EMS fellowship director at
Newark Beth Israel Medical Center/Barnabas Health. He also serves as medical director for
the New Jersey State Police SWAT Team.
1. Trautner BW, Caviness AC, Gerlacher GR, et al. Prospective evaluation of the risk of serious bacterial
infection in children who present to the emergency department with hyperpyrexia (temperature
of 106 degrees F or higher). Pediatrics. 2006;118( 1): 34–40.
2. Offringa M, Newton R, Gozijnsen MA, et al. Prophylactic drug management for febrile seizures in
children. Cochrane Database Syst Rev. 2017;2:CD003031.
3. Geudj R, Chappuy H, Titomanlio L, et al. Do all children who present with a complex febrile seizure
need a lumbar puncture? Ann Emerg Med. 2017;70( 1): 52–62.
4. Moore MR, Link-Gelles R, Schaffner W, et al. Impact of 13-valent pneumococcal conjugate vaccine
used in children on invasive pneumococcal disease in children and adults in the United States:
Analysis of multisite, population-based surveillance. Lancet Infect Dis. 2015; 15( 3):301–309.
5. Leibovitz E, Nuphar D, Ribizky-Eisner D, et al. The epidemiologic, microbiologic and clinical picture
of bacteremia among febrile infants and young children managed as outpatients at the emergency
room, before and after initiation of the routine anti-pneumococcal immunization. Int J Environ Res
Public Health. 2016; 13( 7):723.