Birmingham assessment of breathing study (BABS).

BACKGROUND: Current international resuscitation guidelines for lay people rely on the assessment of "normal breathing" as a key sign of breathing and circulation. However, it is not known how accurately laypersons can discriminate between "normal" and "abnormal" breathing. The aim of this study was to test the ability of medical students to discriminate between simulated normal and abnormal breathing patterns and select the correct treatment.
METHODS: Six video clips of simulated breathing were recorded showing: normal; abnormal -shallow, rapid, agonal (obstructed and unobstructed airways); or absent breathing. The clips were validated by three experienced emergency practitioners and then shown in a random order to 48 second-year medical students. For each clip observers were asked to indicate: "Is this patient breathing?" (yes-normal, yes-abnormal, no) and "What action would you take?" (rescue breathing or recovery position).
RESULTS: All experts correctly identified the breathing type and agreed on an appropriate emergency action. Students identified normal breathing as: normal 61%, abnormal 33% and absent 6%; abnormal breathing as: normal 29%, abnormal 61%, absent 10%; and absent breathing as: normal 8%, abnormal 6%, absent 85%. Correct actions were selected in 86% during normal breathing, 51% during abnormal breathing and 86% during absent breathing. The sensitivity for observers correctly identifying normal from abnormal breathing was 60% and specificity 75% and for selecting the correct action was 42% and 80%, respectively.
CONCLUSIONS: Medical students were unable to identify normal breathing from abnormal breathing reliably resulting in a high number of inappropriate, potentially harmful actions. Further evaluation of the optimal method for assessing for signs of breathing and circulation is required.