Temperature monitoring and mapping in ground emergency medical services (GEMS) and the Emergency Department: an observational study measuring thermal insults to patients, staff, drugs and equipment

Research question We will investigate how internal ambient temperatures within clinical areas of ambulances and Emergency Departments vary across time, in order to quantify thermal insults (extremes of heat and cold) experienced by patients, staff, medicines and equipment, and diagnostic samples. Background Patients have worsened outcomes and experience when subjected to extremes of temperature. Staff have impaired performance and poorer working life conditions. Medicines and equipment are more prone to degradation and may need mitigations in place. Increasingly, prehospital diagnostic sampling is used both for research and clinically; these may also be impacted by extremes of temperature. Yet currently, little is known about the temperature variations that take place within a Ground Emergency Medical Service (GEMS) ambulance and into the Emergency Department. Aims and Objectives To map and monitor ambient temperatures within a ground emergency medical services (GEMS) ambulance clinical setting and into a hospital Emergency Department. This will include the following specific objectives: 1. To record and summarise temperatures experienced at different positions within an ambulance 2. To see if this varies between locations within the Yorkshire region 3. To relate temperature to activity on the vehicle, such as when it was unoccupied, occupied by staff only or occupied by staff and patients 4. To take into consideration the effect of ambient environments on temperatures within the ambulance and the Emergency Department Methods We propose to place ambient temperature monitoring devices within several ambulances in positions occupied by crews and patients, as well as areas used for medicines storage, as well as in locations within an Emergency Department. We would capture a 12-month period of data to include minimum and maximum temperatures, as well as mean kinetic temperatures (MKT) which express the overall effect of temperature fluctuations across a longer period. We would identify three periods of interest: Periods when the ambulance was occupied by a patient as well as the crew Periods when the ambulance was occupied by crew only, such as responding to cases Periods when the ambulance was unoccupied, for example when not in use between shifts. These time periods will require some manual data abstraction, for example to determine whether a patient was being cared for physically on the ambulance, or "cohorted" by a crew inside a hospital building, as well as interpretation of contextual factors such as whether ambulances were stored inside or outside. It is important to be able to characterise these three periods as temperature excursions which do not impact on human comfort or health in period 3, may nonetheless be important for medicine and device storage. Anticipated Impact and Dissemination This research could better inform decisions ranging from medicines storage, through vehicle design, patient care policies, uniform options, staff wellbeing policies, and hospital handover processes. In the longer-term, it could inform hospital and ambulance station physical estate design. A similar study in the air ambulance setting resulted in changes to operational uniform, relocation of medicines within the helicopter, and process changes to remove medicines during extreme external ambient temperatures.