Take A Breath
January 14, 2020
The Academy is at it again, seldom stopping to pause for a breath particularly in the evolution of Dispatch Life Support (DLS) tools.
A recent test of the existing Breathing Verification Diagnostic Tool (BVDxT) was provided in the form of a survey (powered by surveymonkey.com) that elicited comments about the ease in getting the breathing count started to achieve optimal results. In other words, is the BVDxT working to the patient’s optimal benefit? Does the caller understand when the counting begins?
Well, that’s what the survey is trying to find out, and results from the first four days of posting indicate that a change is very well on the horizon for the BVDxT. Nearly 1,000 emergency medical dispatchers had accessed the survey to chime in on the opening statement: Okay, I want you to say now every single time s/he takes a breath in, starting immediately.
Apparently, based on the preliminary results, most respondents tend to find the statement lacking specificity in their ranking of the existing statement and of some of the four others developed for the study. Comments added in the space provided in the survey indicated that callers are often unclear on when to start or stop the count, as it’s currently worded.
The phrase “starting immediately” tends to confuse the caller, explained Chris Olola, Ph.D., IAED™ Director of Research and Biomedical Informatics. As shown in respondent rankings, a slight, although more precise, re-wording could improve the tool’s effectiveness in future applications.
Preliminary results (more responses still coming in at this date) favor adding the words “…ready, Go” to the end of the statement. The words “…ready, Go” prepare and tell the caller exactly when to begin in the process. The word clarifies when and grabs the caller’s attention.
Why is this important?
The DLS tools are an integral part of the “seconds count” world of emergency dispatch, and in a nonvisual environment, callers need simple, easy-to-understand “verbal pictures” to follow. During the evolution of bystander CPR, for example, overly complicated and confusing CPR sequential training instructions would cause people to hesitate and, consequently, delay the procedure or simply give up.1
A similar concept applies to the BVDxT. Confusion of when to begin counting can confound each subsequent step in determining the correct Chief Complaint, Determinant Code, and use of a PAI.
An EMD uses the diagnostic tool in cases when the caller indicates that an unconscious (collapsed) patient is breathing, but the EMD wants to verify that the reported breathing is effective or the EMD suspects the reported breathing might be AGONAL. It is used to verify effective breathing, not when the breathing appears to be UNCERTAIN or AGONAL.
The tool in ProQA® calculates the patient’s breathing rate based on the time elapsed between each of the four breaths counted. After the fourth breath, the tool calculates the breathing rate (breaths per minute) and provides an answer choice recommendation (slow or normal breathing, for example). If the answer choice is Slow Rate for an unconscious patient, the EMD is instructed to repeat the diagnostic within 60 seconds to confirm effective breathing. ProQA will save the rate value and compare it with the second check. If slower than the first check it will provide Slow Deteriorating Rate (consider AGONAL) choice and then select AGONAL breathing rate (Ineffective Breathing) in Protocols 12 and 31. This will trigger the Key Question answer choice of the same name and will be clinically treated the same as AGONAL breathing.
If you’ve been a certified EMD during the past 15 years, it’s highly likely you’ve used the tool. The DLS Link is available from among the most commonly selected Chief Complaints, Protocol 6: Breathing Problems and Protocol 10: Chest Pain/Chest Discomfort (Non-Traumatic)—but can be activated at any time by EMDs.
The high number of responses received a few days into the survey shows the interest “in making the tool even better,” Olola said.
1 Clawson J, Hauert S. “Dispatch Life Support/Establishing Standards That Work.” JEMS. 1990; July. https://www.emergencydispatch.org/system/files/Science%20Tab/Pre-Arrival%20Instructions_Cardiac%20Arrest%20Resuscitation/Dispatch_Life_Support/Dispatch_Life_Support.pdf (accessed Sept. 10, 2019).
About the Author:
Audrey Fraizer is managing editor of the Journal of Emergency Dispatch.