Blood pressure (BP) is an essential physiological parameter for assessing patient condition. In pre-hospital emergency situations it is measured at the arm over the patient's clothing when the patient cannot be undressed.

However there is no study proving the reliability of this measurement compared to measurement according to recommendations (blood pressure cuff).

This lack of proof could lead to misinterpretation when measurement conditions are not optimal.

The study will be conducted in the Emergency Department (ED) of Grenoble University Hospital.

The main objective of this observational study is to assess variations in blood pressure measurements based on the patient's clothing layers compared to the reference blood pressure measurement on the bare arm.

Once admitted to the Emergency Department (ED) the patient may be enrolled in the study according to the inclusion and non-inclusion criteria and after obtaining his consent.

Several series of blood pressure measurements are taken:

• A series taken on the bare arm as control

• A series of measurements using sleeves of different thicknesses in random order.

  3 types of sleeves will be used for which 3 measurements will be realised. A total of 12 measurements will be taken for each patient.

These measurements will be taken during the waiting period between the patient's initial assessment by the Triage Nurse upon arrival and their transfer to the emergency department assignment unit thereby ensuring that the patient's normal care is not delayed.

All measurements will be performed by the investigator using the same blood pressure monitorind device.

For each measurement systolic and diastolic blood pressure are collected and used to estimate a MAP.The average of the 3 values obtained are compared to determine whether there is a significat difference between the MAP measured over a layer of clothing (i.e a sleeve) and that measured on a bare arm .

Regarding the sleeves three sleeves thicknesses will be tested :

• a thin sleeve (base layer + technical fleece vest)
• a thick sleeve (thin layer + down jacket + windproof interface Gore - Tex type)
• a "canyon" type sleeve ( neoprene wetsuit)

These sleeves will be provided by the investigators and will remain the same throughout the study.

Inclusion Criteria:

• Patient over 18 years admitted to the emergency department of Grenoble University Hospital
• No objection by the subject to the study
• Affiliated to the French social security system (or equivalent)

Exclusion Criteria:

• Physical inability to collect BP at the admission in the emergency department (pain, arm wound)
• Technical inability to collect BP at the admission in the emergency department (incompatible size of the cuffs)
• Medical or surgical contraindication to repeated blood pressure measurement on both arms
• Patient who received antihypertensive treatment within the hour prior to measurements
• Unable to communicate or non-french speaking patients or those with impaired comprehension or consciousness
• Protected persons referred to in articles L1121-6 and L1121-8 of French public health code (deprived of liberty, tutorship or curatorship)
• The patient already enrolled in the study

patient admitted in the Emergency department of Grenoble University Hospital

The international writing and publication rules (The Uniform Requirements for Manuscripts of the ICMJE, April 2010) will be followed. The minimum anonymized source data for performing the statistical analysis will be made public at the time of publication, with the article, or deposited in an appropriate public database. Other anonymized data may be available from the principal investigator upon reasonable request and with the consent of the sponsor.

In accordance with the French law n ° 2002-303 of March 4th, 2002, the subjects can be informed, at their request, of the overall results of the research. In this study, the investigators commit to individually communicating the overall results to each subject participating in the research by a short (popularized) summary and associated with a copy of the scientific article.

At the time of publication

The international writing and publication rules (The Uniform Requirements for Manuscripts of the ICMJE, April 2010) will be followed. Moreover, In accordance with the French law n ° 2002-303 of March 4th, 2002