When a person is struggling to breathe, immediate, calm, and purposeful action is required. The information a bystander gathers can be critically important for emergency medical services (EMS) to quickly understand the severity and possible cause of the distress. Rapid information gathering helps bridge the gap between the emergency and the arrival of professional care. The primary goal is to collect specific details about the immediate complaint and the victim’s medical background without causing further anxiety.
Establishing Safety and Initial Communication
First, ensure the environment is safe for both yourself and the victim. Immediately call 911 or your local emergency number, or direct another bystander to do so, providing the exact location and a brief description of the problem.
Approach the victim calmly and introduce yourself, maintaining a reassuring tone since panic can worsen respiratory symptoms. Check for responsiveness by speaking clearly and asking if they can hear you. If they are able to speak, ask for permission to help them. If they cannot speak in full sentences—a common sign of severe distress—ask questions that can be answered with a simple nod, shake of the head, or a single word.
Clarify that you are gathering this information to quickly relay it to the paramedics who are on their way. This transparency helps build trust and encourages the victim to focus their limited energy on communication. Note non-verbal cues, such as a frantic look, use of accessory neck muscles for breathing, or inability to lie flat, to pass on to the responders.
Assessing the Immediate Respiratory Complaint
The most pressing questions focus on the current episode of difficulty breathing to determine its characteristics and severity. Start by asking, “When did the difficulty breathing start?” to establish the onset. Note whether it was sudden (suggesting a collapsed lung or pulmonary embolism) or gradual (indicating a flare-up of a chronic condition). Follow up with: “Can you describe the feeling in your chest or throat?” to understand the quality of the sensation, such as tightness, burning, or an inability to draw a full breath.
To gauge the intensity, ask the victim to rate their shortness of breath on a scale of 0 to 10. Ask, “Is this the worst it has ever been, or has this happened before?” If the victim has a chronic lung disease (like asthma or COPD), ask if the current symptoms feel better or worse than their typical episode.
Inquire about factors that change the symptom by asking, “Does anything you do make the breathing better or worse?” Specifically, ask if breathing is worse when lying flat (orthopnea, suggesting heart failure), or if sitting up and leaning forward brings relief. Finally, ask about associated symptoms, such as chest pain, a cough, or wheezing, and if they are coughing up any phlegm, noting its color or consistency.
Gathering Critical Medical History
While assessing the immediate complaint, collect background information vital for EMS treatment planning. This medical history is often structured using a quick assessment framework focusing on five key areas:
- Allergies: Ask about any known allergies, particularly to medications or foods.
- Medications: Inquire about all current medications, including prescription drugs, over-the-counter remedies, supplements, inhalers, or home oxygen. Note the name and dose of any heart or breathing medications.
- Past Medical History: Focus on conditions like asthma, COPD, heart disease, diabetes, or any recent surgeries. This helps narrow down the potential cause of the respiratory distress.
- Last Intake: Determine the last thing the victim ate or drank, including the time, as this information is important in case a medical procedure is required.
- Events Leading Up: Ask whether they were exercising, exposed to a known allergen, or if symptoms started while sleeping. Also, inquire about their smoking history and any occupational exposure to dust or chemicals.
Actions While Awaiting Help
Once the information has been gathered, your focus shifts to comfort, monitoring, and preparation for the arrival of the EMS team. Help the victim into a position that makes their breathing easiest, which is typically sitting upright or leaning forward, often referred to as the tripod position. Do not force them into any position, but let them choose what feels most comfortable.
If the person has a prescribed rescue medication, such as an asthma inhaler or an epinephrine auto-injector, help them use it according to their instructions, if they are able. The person should not be left alone at any point, as their condition could rapidly worsen. While waiting, continuously monitor their appearance for signs of deterioration, such as a change in their level of consciousness, increasing pallor, or a bluish tint around the lips or fingertips, which suggests a lack of oxygen.
Ensure the environment is prepared for the arrival of paramedics by unlocking the front door and, if possible, having someone wait outside to guide the responders. All the information you have gathered—the medical history, medications, and details of the current respiratory episode—should be written down or kept clear in your mind so you can hand it over to the EMS team immediately upon their arrival.