The importance of lay descriptors of respiratory symptoms: a retrospective analysis of under-triaged emergency calls

Accurate triage of respiratory emergencies during emergency calls is critical but may be compromised when dispatchers misinterpret lay language. Nonspecific descriptors may be perceived as the presence of breathing despite indicating severe conditions like airway obstruction or agonal breathing. The objective of this study was to identify common descriptors used by callers in underestimated respiratory emergencies and assess how these terms may contribute to under-triage. This retrospective cohort study analysed 382 emergency calls received between 2018 and 2023 at the 118 Emilia Est Emergency Medical Communication Centre in Bologna, Italy. All included calls were initially assigned low-to-moderate urgency for a respiratory problem but were later classified as critical or in cardiac arrest by ambulance crews, requiring advanced life support interventions. Experienced dispatchers independently reviewed audio recordings to identify lay descriptors, dispatcher questioning patterns, and pre-arrival instructions. In 29.3% of cases, callers used vivid, nonclinical language to describe respiratory distress. The most frequent lay term was “phlegm” (n=68), followed by “rattle” (n=22), and “cough” (n=7). Dispatcher questioning remained limited, and prearrival instructions were rare (5.2%). Oxygen saturation was reported in 19.4% of calls. Terms such as “phlegm” may reflect severe respiratory compromise when used by lay callers but are often under-recognized by dispatchers. Training should emphasize the interpretation of informal language and encourage structured follow-up questions to reduce under-triage and improve the early identification of critical respiratory events.