Why treatment of fever is not prioritized in the care of patients by Paramedics in the prehospital world​

Reviewing some FACTS and MYTHs

Common Statements about Prehospital Treatment of Fever

"A fever needs to be treated": MYTH*​

Fever is a normal response to infection and itself does not cause harm​

Medication is not always required ​

“Medications are not always needed to reduce a child’s temperature. They can be used to relieve any aches and pains, and to make your child more comfortable.”​

• Canadian Pediatric Society​

*Exception: The only evidence-based role for treatment of fever, is with traumatic brain injury (TBI) ​

"As soon as I get to the hospital, they treat the fever" (and ask me why I didn’t)​

• In hospital, they will DOCUMENT the fever, take bloodwork and often simultaneously treat the patient’s fever​​
• Why are each of these important​
  • Documentation of a fever in-hospital can change a patient’s course of treatment and management​
    • If certain criteria are met, then the patient's management is drastically different​
      • Example: neutropenia found on bloodwork + fever ​
• Hospital staff frequently have misunderstandings about paramedic scope of practice and can lead to inappropriate expectations

"It can help prevent febrile seizures": MYTH​

• There is no difference in seizure recurrence with antipyretics vs. no fever treatment​
  • Cochrane Database Systematic Review 2012​
  • Metanalysis (Rosenbloom E, et al. Eur J Paediatr Neurol 2013)

"It will make the patient FEEL so much better"​

You can utilize Acetaminophen and/or Ibuprofen for myalgias, headache or other discomfort associated with the fever​

1. Remember to DOCUMENT and reiterate a fever was found in handover​
2. Keep in mind the risks of treating a fever prehospital​​

"It will help bring down a patient’s heart rate"​

• Antipyretics may do these things - these are the BENEFITS​

"I already carry acetaminophen and ibuprofen"​

• YES – For the treatment of pain. ​
• A BHP patch is required for an order to use these medications outside of the Analgesia Medical Directive. Patching to the BHP should be for critical interventions.

Risks/Harm of Prehospital Treatment of Fever

What is the harm?​

• If a fever is treated and the patient does not have a fever upon triage at the emergency department, this can negatively impact them​
  • Patients that have a DOCUMENTED fever + other findings have different treatment paths​
  • Example: Sepsis​
    • IF documented fever is missed and appropriate care for sepsis isn't initiated, patients could have poor outcomes​
    • Patients with a “Fever card” are told not to take medication to reduce their fever prior to arriving at the ED in order for accurate assessment of patient condition to be completed by hospital care team

Summary​

• A fever needs to be treated: MYTH​
• As soon as I get to the hospital, they treat the fever (and ask me why I didn’t): Different scopes of practice and care​
• It can help prevent febrile seizures: MYTH​
• It will make the patient FEEL so much better (it may)​
• It will help bring down a patient’s heart rate (it may)​
• I already carry acetaminophen and ibuprofen: For another indication​
• What is the harm?​
  • Can cause patients to have missed opportunities for important treatment (sepsis) due to absence of documented in-hospital fever​
  • Patching to BHP should be for critical interventions

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