Checking for breathing: Evaluation of the diagnostic capability of emergency medical services personnel, physicians, medical students, and medical laypersons

Study objective: International guidelines for cardiopulmonary resuscitation (CPR) recommend determination of unconsciousness, breathlessness, and abse nce of pulse to diagnose cardiorespiratory arrest. Thus far, there have bee n no scientifically proven data available regarding the quality of assessin g breathlessness. The study objective was to evaluate the effectiveness of checking for breathing in an emergency situation, to determine the necessar y amount of time until diagnosis, and to document used techniques. Methods: Four different populations were tested for their ability to assess breathlessness: emergency medical services (EMS) personnel, physicians, me dical students, and laypersons. Each participant was asked to perform the d iagnostic procedure twice, first with a breathing or not-breathing unrespon sive test person and then with a modified megacode manikin (with the possib ility of simulated respiratory function). The order of testing and the resp iratory status were strictly randomized. Diagnostic accuracy, time interval to diagnosis and used techniques were documented. Results: A total of 261 persons were tested in 522 trials, with a median ti me interval of 12 seconds for obtaining a diagnosis. Regarding all particip ants, the correct diagnosis was achieved in 81.0% (EMS personnel, 89.7%; ph ysicians, 84.5%; medical students, 78.4%; laypersons, 71.5%). Only 55.6% of all participants showed correct diagnostic skills (EMS personnel, 91.3%; p hysicians, 51.5%; medical students, 61.9%; laypersons, 18.5%). Conclusion: Checking for breathing was shown to be mostly inaccurate and un reliable. This diagnostic procedure takes more time than recommended in int ernational guidelines. Therefore CPR training should focus more on the dete rmination of breathlessness. Also, the guidelines for CPR should be revised .