Bystander Effect and Cardiac Arrest

Don't Doubt Yourself

Under three minutes. That’s the optimal time period for someone in sudden cardiac arrest (SCA) to receive defibrillation. It’s not a lot of time. CPR should be started as soon as someone collapses, is not breathing, and is unresponsive. Ideally immediately. Most of us like to feel we would jump in and do the right thing in an emergency situation. Statistics show, however, the more people who are present, the less likely anyone is to address the plight of the person in distress. This is known as the “bystander effect” and it can have dire consequences if someone is in SCA.

What Is the Bystander Effect?

Very simply put, the bystander effect is when everyone in a group assumes someone else in the group is going to do something, so they all do nothing and the person in distress is left without help. Thoughts which may run through a bystander’s mind might be:

• “Maybe someone in all these people is a medical professional, and I’m not.”
• “Maybe I’ll hurt the person further.”
• “What if I get sued if I try to help and they die anyway?”

Pluralistic Ignorance

Similar to the bystander effect, pluralistic ignorance stems from our fear of standing out or looking foolish in a group situation. The thought process is “What if they really aren’t hurt? Nobody else seems concerned, should I be?” The human fear of overreacting in a group of strangers keeps bystanders from drawing attention to themselves by attending to someone in distress.

Differences Between the Bystander Effect and Pluralistic Ignorance

Both the bystander effect and pluralistic ignorance are usually not a factor in several instances. One is if the person in cardiac arrest is a friend or loved one, and the other is if the bystanders are part of a group of friends. When there is less perceived judgment, or when the abilities of those close by are known, people are more willing to act.

Preparing Yourself to Respond

As stated earlier, time is critical to the person’s survival. In the time it takes to look around and deliberate on whether there is someone better qualified, more willing to step in, who can take the initiative, YOU can start the process of getting help.

Let’s step back from that for a moment. Pause and really imagine that situation: you’re having coffee, and a stranger at the table next to you falls out of his chair onto the floor, gasping for breath. If the thought of taking charge and telling your fellow coffee drinkers what to do makes you squirm, you’re in good company. Most people feel like that, otherwise there wouldn’t be a bystander effect. As members of a society, though, we depend on each other in situations like this.

You may not be a CPR instructor or someone who actually prepares for this scenario on a daily basis, but you can still go through a short exercise of preparing to respond.

1. Imagine the situation of someone collapsing in a public place (a park, restaurant, mall, any place that comes to mind).
2. Imagine how you’d feel: startled, afraid, confused about what’s going on, maybe like you wanted to leave, or perhaps something else. It’s ok to feel all those things; it’s an unusual and loaded situation.
3. Consider how you might want yourself to act if the stranger actually was in sudden cardiac arrest. Would you want to respond? Would you want to help save this person’s life? Would you give CPR or find an AED? Tell someone else to? Call 911? Think about what actions you would want to take.
4. Imagine yourself doing those things: telling someone to call 911, calling out to people around you for an AED, asking if anyone knows CPR, etc.

Though it may feel uncomfortable or even silly to imagine how you might react in a situation where someone’s collapsed in public, it’s a valuable exercise to consider ahead of time. If you’re aware of the very natural fear of looking like you’re overreacting or even being wrong (or fill in your own blank) and can acknowledge it and then think about how you’d hypothetically respond, you’ll be more likely to respond well in reality.

Call It Out

If someone is having a heart attack or some other trauma where they are able to speak and can identify their problem, they are more likely to receive help if they call people out by name (if they know it) or by color of their shirt or some other distinctive visual attribute and ask for help, “You, in the blue parka! Can you call 911? I believe I am having a heart attack.” This allows bystanders to know exactly what the problem is and what the person in distress needs them to do.

Alternatively, if you see someone collapse and they cannot tell you what is wrong, assess the scene and if it is safe, approach them to investigate:

• See whether they are breathing normally and if they respond when shaken lightly by the shoulders.
• Call out to them, “Are you ok?” If no response and no normal breathing are present, then begin CPR immediately.
• Start calling out to those around you while pointing, “You! With the pink tank top – call 911! Does anyone know if there is an AED nearby? You, with the yellow backpack, see if you can find one! I’m going to start CPR.”
• Begin CPR. Ask, “Does anyone else know CPR that can assist me?” Continue compressions until the AED arrives.
• Continue care until Emergency Medical professionals arrive.

If anyone you request assistance from does not respond or do as they are asked, move on to the next person. It is far more comfortable to sit on the sidelines than jump into the fray, but people are more apt to help if they are asked or directed by someone who seems to have taken control of the situation.

Even if you are not confident, the appearance of confidence is calming to other bystanders. Remember that the discomfort of looking foolish or even being wrong and overreacting is temporary, and someone’s life may be saved by your willingness and readiness to act, even if you feel awkward.