title: Checking for breathing: evaluation of the diagnostic capability of emergency medical services personnel, physicians, medical students, and medical laypersons.
abstract: OBJECTIVE
  International guidelines for cardiopulmonary resuscitation (CPR) recommend determination of unconsciousness, breathlessness, and absence of pulse to diagnose cardiorespiratory arrest. Thus far, there have been no scientifically proven data available regarding the quality of assessing breathlessness. The study objective was to evaluate the effectiveness of checking for breathing in an emergency situation, to determine the necessary 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, medical students, and laypersons. Each participant was asked to perform the diagnostic procedure twice, first with a breathing or not-breathing unresponsive test person and then with a modified megacode manikin (with the possibility of simulated respiratory function). The order of testing and the respiratory 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 time interval of 12 seconds for obtaining a diagnosis. Regarding all participants, the correct diagnosis was achieved in 81.0% (EMS personnel, 89.7%; physicians, 84.5%; medical students, 78.4%; laypersons, 71.5%). Only 55.6% of all participants showed correct diagnostic skills (EMS personnel, 91.3%; physicians, 51.5%; medical students, 61.9%; laypersons, 18.5%).
  
  
  CONCLUSIONS
  Checking for breathing was shown to be mostly inaccurate and unreliable. This diagnostic procedure takes more time than recommended in international guidelines. Therefore CPR training should focus more on the determination of breathlessness. Also, the guidelines for CPR should be revised.
authors.affiliation: Institute for Emergency Medicine and Prehospital Care, University of Munich, Medical School, Munich, Germany. matthias.ruppert@anr.med.uni-muenchen.de
authors.forename: M
authors.initials: M
authors.lastname: Ruppert
authors.forename: M W
authors.initials: MW
authors.lastname: Reith
authors.forename: J H
authors.initials: JH
authors.lastname: Widmann
authors.forename: C K
authors.initials: CK
authors.lastname: Lackner
authors.forename: R
authors.initials: R
authors.lastname: Kerkmann
authors.forename: L
authors.initials: L
authors.lastname: Schweiberer
authors.forename: K
authors.initials: K
authors.lastname: Peter
mesh_terms: D001049:Apnea / Q000175:diagnosis*; D002983:Clinical Competence; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004630:Emergencies; D004632:Emergency Medical Services; D005858:Germany; D006801:Humans; D010820:Physicians / Q000592:standards*; D012119:Respiration; D012680:Sensitivity and Specificity; D013337:Students, Medical; D000078329:Workforce