The "severe difficulty in breathing" issues is entirely the fault of that lousy american dispatching system which makes us ask "Are they breathing normally?" and, if they are not, "Are they able to talk normally?" How anyone is expected to talk normally with a broken ankle is beyond me, and I do try to get the callers to distinguish between Gasping With Pain and Can't Breathe Properly, although I'm not really supposed to do that and QA will come round and bombard me with pink pieces of paper if I do it too often. I often find "conscious" is a word that baffles the callers - they seem to think it applies to anyone lying down or anyone who will not speak to them. This is worryingly prevalent in nursing homes. There are also a lot of people (particularly new mothers) who think that someone cannot be breathing if they are crying. I am frequently deafened by reportedly "suspended" babies crying down the phone.