Abnormal respiration rate (RR) is commonly undervalued in the out-of-hospital environment despite its use as a predictive marker for physiological decline. The need for paramedicine students to manually measure RR is therefore important. The aims of the study were: 1) to determine the accuracy of manually measured RR when performed by second-year paramedicine students on healthy volunteers in a simulated environment; and 2) to provide data to inform design of a larger study.
This pilot study utilised a prospective double-blinded observational design, in which neither the participants nor the healthy volunteers knew the specific aim of the study. Paramedicine students manually recorded RR along with a range of vital signs including non-invasive manual blood pressure, heart rate, oxygen saturation, temperature and 4-lead electrocardiogram on healthy volunteers. Capnography was used as the gold standard to confirm observed respiratory rates. Intra-class correlation was used to assess agreement between manual RR and capnography.
Thirty-six complete sets of data were recorded. There was strong agreement between paramedicine student and capnography measurements (ICC 0.77; 95% CI 0.54–0.88). Accuracy of paramedicine students to measure RR of the opposite gender showed no statistical difference when female students (F=0.05, p=0.83) or male students (F=0.04, p=0.84) measured.
The manual RR measured by paramedicine students agreed well with capnography irrespective of the gender of the patient or paramedicine student. These data suggest the two measurements could be used interchangeably, although the difference between statistical and clinical significance should be further investigated.
Boyle M, Williams B, Sawyer S. The accuracy of undergraduate paramedic students in measuring blood pressure: a pilot study. Australasian Journal of Paramedicine 2014;11(2).
Crosley A, Rose J. Knowledge of accurate blood pressure measurement procedures in chiropractic students. J Chiropr Edu 2013;27:152-7.
Smith I, Mackay J, Fahrid N, Krucheck D. Respiratory rate measurement: a comparison of methods. British Journal of Healthcare Assistants 2011;5:18-23. Available at: http://dx.doi.org/10.12968/bjha.2011.5.1.18
Bristow P, Hillman K, Chey T, et al. Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team. Med J Aust 2000;173:236-40. Available at: www.mja.com.au/journal/2000/173/5/rates-hospital-arrests-deaths-and-intensive-care-admissions-effect-medical
Fieselmann J, Hendryx M, Helms C, Wakefield D. Respiratory rate predicts cardiopulmonary arrest for internal medicine inpatients. J Gen Intern Med 1993;8:354-60. Available at: http://dx.doi.org/10.1007/bf02600071
Grossman P. Respiration, stress, and cardiovascular function. Psychophysiology 1983; 20:284-300. Available at: http://dx.doi.org/10.1111/j.1469-8986.1983.tb02156.x
Smith G, Prytherch D, Schmidt P, et al. Hospital-wide physiological surveillance: a new approach to the early identification and management of the sick patient. Resuscitation 2006;7:19-28. Available at: http://dx.doi.org/10.1016/j.resuscitation.2006.03.008
Cretikos M, Bellomo R, Hamilton K, Chen J, Finfer S, Flaboris A. Respiratory rate: the neglected vital sign. Med J Aust 2008;188:657-9. Available at: www.mja.com.au/journal/2008/188/11/respiratory-rate-neglected-vital-sign
Husum H, Gilbert M, Wisborg T, Van Heng Y, Murad M. Respiratory rate as a prehospital triage tool in rural trauma. J Trauma 2003;55:466-70.
Parkes R. Rate of respiration: the forgotten vital sign. Emerg Nurse 2011;9:12-7.
Williams B, Boyle M, O'Meara P. Can undergraduate paramedic students accurately identify lung sounds? Emerg Med J 2009;26:580-2.
Philip KE, Pack E, Cambiano V, Rollmann H, Weil S, O'Beirne J. The accuracy of respiratory rate assessment of doctors in a London teaching hospital: a cross sectional study. J Clin Monit Comput 2015;29:455-60.
Lovett P, Buchwald J, Sturmann K, Bijur P. The vexatious vital: neither clinical measurements by nurses nor an electronic monitor provides accurate measurements of respiratory rate in triage. Ann Emerg Med 2015;45:68-76.
Duckitt R, Buxton-Thomas R, Walker J, et al. Worthing physiological scoring system: derivation and validation of a physiological early-warning system for medical admissions. An observational, population-based single-centre study. Br J Anaesth 2007;98:769-74.
Elliott M, Coventry A. Critical care: the eight vital signs of patient monitoring. Br J Nurs 2012;21:621-5. Available at: http://dx.doi.org/10.12968/bjon.2012.21.10.621
NSW Government. NSW Ambulance - Ambulance Stations n.d. Available at: www.ambulance.nsw.gov.au/about-us/Map-of-Stations.html