Ineffective Breathing

Brett Patterson

Brett: 

Our Dispatch Review Committee (DRC) had a discussion yesterday on “struggling to breathe.”  

Caller provides that the conscious patient is breathing but is struggling. Would this alone be considered a reasonable equivalent to “fighting for air” as listed in the ineffective/agonal descriptors? I did some research and found the information below in the article “To Use Or Not To Use” on the IAED Journal website so I want to make sure that I am relaying this information correctly to our supervisors. 

The first is when you, the EMD, have reason to believe that the caller may be mistaken in reporting that the patient’s breathing is effective. Secondly, you should use the tool when the caller answers Case Entry Question “Is s/he breathing?” with “Yes, but …” (“Yes, but it sounds funny” or “Yes, but it sounds like they’re struggling”). 

Michelle Haynes 

EMD Quality Performance Improvement Coordinator 

Weld County Regional Communications 

Greeley, Colorado, USA

Hi Michelle:  

The simple answer is no when considering only the term. 

The terms listed in the INEFFECTIVE BREATHING list of the protocol have a strong correlation with severe distress, but they are not all-inclusive, nor are they 100 percent conclusive. In other words, while it is certainly possible for a patient to have INEFFECTIVE BREATHING without one of these terms as evidence, it is also possible for INEFFECTIVE BREATHING to be present when other terms are used. This is why it is important for EMDs to have an understanding of what we are looking for with regard to INEFFECTIVE BREATHING. Dr. Jeff Clawson sums this up well: “They are circling the drain.” 

I’m sure you can imagine a patient described as “struggling to breathe” who is not in severe respiratory distress and, in my experience, this is the most common scenario, versus “fighting for air,” a description often used to describe the asthma patient in extreme circumstances. However, if there is other evidence of severe distress, i.e., severe wheezing or gasping in the background, the EMD should err on the side of caution and choose INEFFECTIVE BREATHING. 

In summary, the listed INEFFECTIVE BREATHING terms have a strong correlation to severe respiratory distress and should be cause for action alone, unless the 1st party patient is speaking in full sentences. Other terms should be taken in context with the patient’s presentation. When in doubt, send ‘em out. 

Hope this helps. 

Brett A. Patterson 
Academics & Standards Associate 
Chair, Medical Council of Standards 
International Academies of Emergency Dispatch    

Brett:  

That helps tremendously. This was a debatable topic for us yesterday, and I wanted to get the ineffective breathing expert’s opinion so we could move forward. As always, appreciate you! 

Take care,  Michelle 

Brett Patterson is Academics & Standards Associate and Chair of the Medical Council of Standards for the IAED. His role involves protocol standards and evolution, research, training, curriculum, and quality improvement. Prior to working with the IAED, he spent 10 years working in the Pinellas County EMS System, Florida. He answers members’ protocol questions in the Journal FAQ column. (brett.patterson@emergencydispatch.org) 

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