Checking for Breathing: Evaluation of the Diagnostic Capability of Emergency Medical Services Personnel, Physicians, Medical Students, and Medical Laypersons☆,☆☆,★,★★
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INTRODUCTION
International guidelines for cardiopulmonary resuscitation (CPR) provide algorithms for basic life support (BLS) and advanced life support (ALS) to standardize assessment and treatment of patients undergoing cardiac arrest.1 In 1992, the American Heart Association (AHA) published “Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC)” as a contribution to the 1992 “National Conference on CPR and ECC,” in which former recommendations were updated by a consensus of
MATERIALS AND METHODS
The study was performed at the Ludwig-Maximilians-University Medical School, Munich, Germany. Each participant had to complete 2 independent test runs in a strictly randomized order. He or she had to check for breathing in a presumed emergency situation, once with an unresponsive test person and once with a specially modified megacode manikin. The breathing status of the manikin and of the test person (spontaneous breathing versus nonbreathing) had been determined independently for both
RESULTS
A total of 261 participants were included in this study. According to the study design, 522 assessments took place. The 4 groups of participants consisted of 63 EMS personnel (126 assessments), 66 physicians (132 assessments), 67 medical students (134 assessments), and 65 laypersons (130 assessments).
EMS personnel of the Munich Fire Department, the Bavarian Red Cross, and 3 other organizations involved in EMS were evaluated. Eighty-one percent of EMS personnel were male, and 19% were female.
DISCUSSION
The experimental setup was designed to place the uninformed provider into an emergency-like situation of finding an unconscious person. After taking part in the experiment, several participants confirmed that they had felt as if they were acting in a real emergency situation.
The study results concerning correctness of diagnoses should be interpreted carefully. At first glance, the percentage of correct diagnoses (81%) seems to be rather good. But checking for breathing means choosing 1 of only
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Address for reprints: Matthias Ruppert, MD, Arbeitskreis Notfallmedizin und Rettungswesen (ANR), Ludwig-Maximilians-Universität München, Nußbaumstraße 20, 80336 Munich, Germany; 49 89 51 60 49 50, fax 49 89 51 60 49 52; E-mail [email protected].
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This article is copublished in Notfall und Rettungsmedizin 1999;2:18-28.
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