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Prehospital clinical diagnosis by emergency medical services (EMS) personnel does not require a thermometer to detect increases or decreases in body temperature. Numerous etiologies can lead to fever (>39 °C or >100.4 °F), hypothermia (<35 °C or <95 °F), or both. Common causes for fever and hypothermia include environmental exposure, endocrinologic disorders (hypothyroidism, hyperthyroidism, hypoglycemia, adrenal insufficiency), and infectious disease, with sepsis more likely when temperature derangements are present. Emergent causes of fever include sympathomimetic substances (eg, methamphetamine, cocaine, phencyclidine), withdrawal toxidromes (eg, benzodiazepine or alcohol withdrawal), drug effects (eg, neuroleptic malignant syndrome, serotonin syndrome), and exertional hyperthermia (eg, marathon running). Emergent causes of hyperthermia also include extensive skin disorders (burns, psoriasis, widespread rash), neurogenic shock with vasoregulation dysfunction, and medication-induced hypothermia (eg, benzodiazepines, β-blockers). Baseline vital signs in EMS include pulse, respirations, skin color, skin temperature, skin condition, and blood pressure. These measurements comprise a critical component of the physical assessment. Skin temperature should be evaluated by tactile examination or, when able, thermometry. Assessment includes determining whether the skin feels cool, normal, warm, or hot. Clinical evaluation of tactile temperature demonstrates accuracy comparable to topical thermometry (eg, temporal), even in untrained personnel. Studies report a sensitivity of approximately 90% for parents’ tactile detection of childhood fever, with a specificity of approximately 50%. By comparison, oral thermometry demonstrates a sensitivity of approximately 55% and a specificity of approximately 98%.[1] Regarding infectious causes of temperature abnormalities, multiple signs and symptoms can indicate associated contagious disease, including chills, rigors, sweats, and altered mental status. Symptoms specific to the infected body system (eg, cough in pulmonary infection, rash in skin infection, abdominal pain in appendicitis) should prompt EMS providers to suspect infection and include it in the differential diagnosis.

Regarding infectious causes of temperature abnormalities, multiple signs and symptoms can indicate associated contagious disease, including chills, rigors, sweats, and altered mental status. Symptoms specific to the infected body system (eg, cough in pulmonary infection, rash in skin infection, abdominal pain in appendicitis) should prompt EMS providers to suspect infection and include it in the differential diagnosis. High suspicion for infectious disease facilitates timely patient treatment and reduces the risk of provider exposure. Although universal precautions apply to all patients, adherence to protocols improves when EMS personnel maintain a high index of suspicion. Proper patient history, clinical presentation, and physical examination support accurate identification of infectious disease. Early recognition of infectious disease substantially reduces mortality, particularly in sepsis.[2][3][4][5][6][7]