New study to highlight vital role medical communications officers have in recognizing agonal breathing

EHS Communications Officers are highly trained and very experienced in identifying when patients need immediate help, and they act as the eyes and ears of responding paramedics, while also providing key instructions to callers. And that responsibility is especially important in recognizing a symptom called ‘agonal breathing’ in cases of sudden cardiac arrest, which is often misinterpreted as a sign of life by the 911 caller. “If we can recognize when a caller says ‘my husband just fell to the floor, he’s not conscious and he’s gasping’, that, for us, should be a trigger to say that that is ineffective breathing,” said Michelle Young, a Communications Officer with the EHS Medical Communications Centre. “So, being able to pick those words up are really important and can save lives. In cardiac arrest, seconds make a difference, so even if we can shave 15 to 30 seconds until we can get them positioned and start CPR, that can have a difference in having a positive outcome.” In Canada, a cardiac arrest happens every 13 minutes. The vast majority of these cases occur in prehospital settings, which makes early recognition, immediately calling 9-1-1, and bystander intervention vital to a positive outcome for the patient. However, bystanders may not be able to recognize the seriousness of a cardiac arrest when agonal breathing is present, and may be reluctant to perform CPR. Agonal breathing - described as short, noisy, laboured or gasping breaths - occurs in 25 per cent of cardiac arrest cases, and this also poses a challenge to 911 and medical communication centre call takers as well. And that’s where medical communications officers can make a big impact in properly diagnosing a cardiac arrest. “The first thing that we have to do is figure out what they’re seeing, and so often times agonal breathing is described in a very specific way. So, it’s usually something like ‘they’re not breathing right’ or ‘they’re gasping’, ‘they’re breathing funny’, ‘they’re snoring’,” Young said. “So picking up on those words in conjunction with the patient not being responsive or not conscious – those are kinds of the first cues that we pick up in order to identify that in what’s called our fast track – which is the fastest way for us to get to CPR instructions.” Data shows that agonal breathing is responsible for 50 per cent of prehospital cardiac arrests being misdiagnosed, resulting in delayed or withheld CPR. This is why it is so important for communication officers to quickly recognize agonal breathing as a sign of cardiac arrest and quickly begin coaching the caller on how to give effective CPR. That’s where education and training are key for medical communications officers to be able to identify that, particularly if the caller is providing incomplete information, Young said. “A lot of times it’s because people don’t either recognize, or there’s so much going on, that they’re almost scared to admit what they’re seeing,” she said. “And, so, it’s something that if we don’t get to that fast track, if they don’t give us that information or if we can’t recognize the words that they use, then we have to ask more questions before we can get to the actual CPR portion.” Aware that recognizing agonal breathing is a significant issue, Dr. Christian Vaillancourt at the Ottawa Hospital Research Institute has conducted extensive research in this area, and has developed a theory-based educational intervention for communications officers. The training was launched in five provinces across Canada, with Nova Scotia being the first to do so on Dec. 17, 2020. Refresher training was launched this past October. Dr. Vaillancourt and his team launched a study to analyze the impact of that training intervention, collecting data one year before and one year after implementation to determine if there was a noticeable increase in bystander CPR rate. Communications centres in Nova Scotia, British Columbia, P.E.I, Calgary, and Ontario, will participate in the study. The Nova Scotia EHS Medical Communications Centre have also previously collaborated with Dr. Vaillancourt on this important research on agonal breathing and how communications officers can recognize it quickly. Judah Goldstein –research coordinator with EHS Operations and assistant professor with the Dalhousie Department of Emergency Medicine, Division of EMS and affiliated researcher with Nova Scotia Health – says his team is reviewing all cardiac arrests in Nova Scotia that meet the eligibility criteria of the current study. Goldstein's team will be looking at the frequency and impact of communication officer recognition of agonal respirations and then initiating dispatch-assisted bystander CPR. While data is still being collected for the study, the research team’s hypothesis is that the bystander CPR rate will increase after the educational intervention, potentially leading to more lives saved. “The goal of the educational program is to improve medical communications centre officers recognition of agonal respiration and then start bystander CPR instructions,” Goldstein said. “And, then, ultimately, if they start instructions more frequently that should lead to an increase in survival for patients in Nova Scotia.” Young said the most important thing for people to do if they see someone collapse, even if they appear to be breathing, is to immediately call for help. Giving early CPR to patients who have collapsed and are in cardiac arrest – with or without agonal breathing – is a key thing bystanders can do to help, and EHS communication officers are there to provide clear instructions to callers when it is needed. “If somebody collapses, call 911 and then you trust what we’re telling you," she said. "Listening to the instructions and trusting what we’re telling you is really important.”