Skip to 0 minutes and 1 secondHi everyone, my name’s Jason. I’m a paramedic, I’ve worked in the pre-hospital environment across the West Midlands in the UK. I’m here to talk to you about febrile illness and how common a presentation that is in the pre-hospital environment The problem with febrile illness is it can cause great anxiety for both parents and carer, and presents complex issues for the pre-hospital practitioner to ensure that they do a thorough assessment to ensure a safe and appropriate management plan for the patient.

Skip to 0 minutes and 30 secondsWe have to remember that febrile illness is still the leading cause of death in the under 5 year olds, and the cause of the fever is difficult to identify and the other problem with fever as well is that it can range from self-limiting illnesses like a viral illness right up to something life-threatening like meningitis and it’s very important for us to be able to distinguish between the two conditions We’re going to discuss what is a fever, the differences, the approaching goals to patient assessment, and then talk about the ability to spot red flags and following all that then we can decide on a safe and appropriate management plan for that patient.

Welcome to the first topic: Fever

Jason Wiles, a Paramedic working in the pre-hospital environment across the West Midlands, will guide you through this topic about febrile illness.

For all those non-medics out there, parts of this topic are quite technical. You may find it easier to first download the Parent Information Leaflet attached to the bottom of this page. This is written in plain English and avoids technical jargon.

The cause of fever in the pre-hospital environment can be difficult to identify. The aim of this session is:

  1. To enable you to understand what fever is
  2. The approach to and the goals of the assessment of the patient
  3. To spot potentially serious underlying illness
  4. To understand what initial treatment is required

Febrile illness (or fever) is one of the most common medical reasons for a child to present to the ambulance service. Fever in a child can be a cause of great anxiety for parents or carers, and presents the pre-hospital practitioner with a number of complex issues to address to ensure a safe and appropriate management plan is implemented for the child. Fever may be a sign of sepsis which remains one of the leading causes of death in children under five. Usually fever indicates some form of bacterial or viral infection which for the majority of patients will be self-limiting. However, for a small number of patients, these infections can be serious in nature and potentially life threatening.

So what is fever? Put simply, it is a high core body temperature. ‘Normal’ body temperature is between 36-37° C and a fever is considered to be a temperature over 38°. In an infection, pyrogens cause a rise in the thermoregulatory set point, which is the body’s internal body temperature setting, through their actions on the neurons of the anterior hypothalamus as well as on peripheral tissues via specific receptors and pathways. As clinicians we should not fear fever, but accept that it is a natural response. The focus should be on identifying the underlying cause rather than concentrating on the the fever itself.

Now that we know about the prevalence of fever and what it is, let’s begin with a simulation and use the questions posed to help you learn a little more about febrile illness in children.

The 999 call

Imagine there has been a 999 call made by the grandmother of a 7-year-old female who has been generally unwell throughout the day. She is sleepy and feels hot to touch. An ambulance is dispatched.

Have a look at these questions. Add your comments below and discuss.

  • What are the priorities for the paramedics and what do they need to consider?
  • What concerns do we have about the case?
  • What red flags are we going to be looking for?
  • How are we going to approach the assessment?
  • What examinations are we going to consider?
For these questions, we have provided the answers in a downloadable pdf below.

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This video is from the free online course:

Emergency and Urgent Care for Children: a Survival Guide

University of Birmingham