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Thermal comfort during emergency transport by ambulance services

02 September 2022
Volume 12 · Issue 3



Cold is an unpleasant sensation and is linked to increased anxiety, pain and risk of hypothermia. A question was developed to test the authors' hypothesis that patients would feel cold while being transported to an Irish emergency department (ED) by the Ambulance Service (NAS).


A survey of a convenience sample of 96 respondents was undertaken, for 77 consecutive hours in March 2020 at University Hospital Limerick's ED. During that period, the NAS transported 163 patients to the ED. A seven-point Likert satisfaction rating scale was used to assess perception. Taking this in combination with a visual assessment of personal insulation and the vehicle's patient compartment heater status, this project endeavoured to determine the passengers' thermal comfort.


Fifty-three per cent of the sample (n=51) were women, 22% (n=21) were escorts and 78% (n=75) were patients. Forty-two patients (56%) were aged >65 years. Of those interviewed, 66.6% (n=64) rated 0 (neutral/comfortable/I didn't notice) at the beginning of their journey and 67.7% (n=65) rated 0 at the end of their journey. Thirteen reported finding the ambulance cold at the beginning of their journey, and five reported still being cold at the end of it. In contrast, 15 respondents found the ambulance warm. The vehicle's patient compartment heater was switched on in 80% (n=69) of the 86 journeys. Transportation had a median time of 27.5 minutes (range: 3–90 minutes). The recorded air temperature at the nearest weather station ranged between −0.8°C and 10.1°C, significantly lower than the average for the time of the year.


During this relatively cold week, two-thirds of passengers rated their thermal comfort in the ambulance as comfortable, 15 were warm beyond comfortable and very few felt cold.

Cold is an unpleasant sensation at best, but has been linked to increased anxiety and pain (Aléx et al, 2014). Cold can lead to accidental hypothermia, where, in restricted physiology, core temperature drops below 35°C. Hypothermia leads to worse clinical outcomes including death (Aléx et al, 2013a).

The authors undertook a structured literature search on the PubMed database, and followed up references cited in articles. The results of this search showed there was a paucity of published literature on the topic of ground ambulance patients' thermal comfort and ambulance care preventing hypothermia.

In two papers, Aléx et al (2013b) interviewed patients of a Swedish ambulance service, who reported they felt cold during transport. Haverkamp et al's (2018) literature review and Lapostolle et al's (2012) HypoTraum study found that all prehospital patients were at risk of becoming hypothermic.

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