TABLE 2

BREATHE intervention and usual care

InterventionExamples of techniques
BREATHE
Be reassuredReassure patient and carer; a reassuring and expert presence is sometimes sufficient to start “unwinding” escalating breathlessness
Resting positionCheck posture; find the most comfortable and efficient position to maximise ventilation
Exercises (breathing)Use to slow breathing rate and encourage breathing out to prevent air trapping (e.g. pursed lip or “breathing rectangle”). Pursed lip breathing also provides increased end-expiratory pressure
AirflowAirflow across lower face/nasal passages can reduce breathlessness and recovery time
The fan was not used at call-out, but recommended for future use#
Use of damp cloth to cool the face#
Windows opened#
Time“Take it easy, nice and slow”
Help with fears and worriesSimple techniques to manage panic and fear
Education of patient/carerInformation booklet and laminated single-page leaflet about BREATHE intervention
Usual care
Immediate clinical assessmentHistory, baseline vital signs and targeted examination (e.g. 12-lead ECG)
ReassuranceReassurance is a mainstay of high-quality patient care
OxygenTime critical feature: oxygen saturations of 94% or less for those patients without chronic lung diseases
Target range oxygen saturation in patients with chronic lung diseases: 88–92%. If SpO2 >92%, oxygen would not be administered
NebuliserDepending on the initial assessment, the paramedic may ask the patient to use their own inhalers, or proceed to nebulisation

SpO2: oxygen saturation measured by pulse oximetry. #: indicates changes from the original protocol due to COVID-19.