Assessment of lung auscultation by paramedics

To determine how accurately paramedics interpret common lung sounds on an audiotape in comparison with emergency physicians.

We carried out a prospective comparison of blinded lung sound interpretation using a standard teaching tape. Our subjects were 67 experienced paramedics and 22 new paramedics from urban and suburban emergency medical services systems comprising municipal and private ambulance providers; and 18 emergency physicians. Five common lung sounds were played three times, in different sequences, and with additional patient history provided for each repetition. The members of each group listened to the same tape and were asked to identify the lung sounds.

Emergency physicians had a median score of five of five possible correct responses in each of the three trials. This score was significantly higher than those of experienced and new paramedics. Experienced paramedics (P = .001) and new paramedics (P = .002) significantly increased their median scores over the three trials with additional medical history. We found no significant difference between experienced and new paramedics in any of the three trials.

In our study, paramedics did not assess lung sounds as accurately as emergency physicians, and experienced paramedics did not interpret sounds more accurately than new paramedics. Correct identification of lung sounds improved significantly for paramedics when medical history was known.