Difficulty breathing: Agreement of paramedic and emergency physician diagnoses

Objective. To determine the diagnostic accuracy of paramedics treating patients who have called an ambulance for "difficulty breathing." Methods. A retrospective study of all ambulance call reports generated by one ambulance over a one-year period with the dispatch complaint of "difficulty breathing" taken to the hospital. The paramedic diagnosis on the call report was compared with the emergency department (ED) physician diagnosis, which was used as the "gold standard." Results. A total of 244 ambulance reports were reviewed. For patients complaining of "difficulty breathing," paramedics achieved 86.4% sensitivity and 86.6% specificity for diagnosing cardiac disease, 71.4% sensitivity and 93.6% specificity for respiratory disease, and 82.1% sensitivity and 91% specificity for other disease processes. There was an interrater agreement of 81.1% between paramedic and ED physician, producing a kappa of 0.71, interpreted as good, approaching excellent, agreement. Conclusion. Paramedics are able to identify the disease process category in patients dispatched as having " difficulty breathing," with a moderate degree of accuracy.