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.

9 Responses to “Bystander Effect and Cardiac Arrest”

December 18, 2018 at 8:13 am, John Hamm said:

You might address the affect that people pulling out their phones to record your actions could have on a stranger’s willingness to rush to the aid of a person in need.
Is there anything I can do or say to feel more in control of the narrative when bystanders are attempting to video me while attempting to give aid–of any kind?

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December 18, 2018 at 9:32 am, AED Superstore said:

Hi John,
An unfortunate fact of living in today’s world is everyone carries a camera/video recorder in their pockets. In a perfect world, people would think to help before they would think to record a tragic situation. While we wish people would be more sensitive to situations, it should be recognized that Good Samaritan laws in all states protect people who step in to help someone in distress. As long as a bystander is acting in good faith, they should not be concerned about being recorded. This fact was not addressed in the article as we are working hard to encourage help, rather than giving people something else to fear. Thank you for taking the time to read the article and commenting!

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December 18, 2018 at 9:49 am, Sigrid Vogelpohl said:

May be a comment such as: It is totally inappropriate to record this. Please stop. What if this was your loved one.

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December 18, 2018 at 9:50 am, AED Superstore said:

Excellent Response!

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December 18, 2018 at 8:35 am, Ted Council said:

Thanks for the information. This is great information that should be made available for all AED/CPR and first aid classes.

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December 18, 2018 at 9:46 am, Sigrid Vogelpohl said:

Thank you for this excellent article. I am an AHA Instructor and RN and know what to do. Yet even for me the article had valuable info for points to mention in class when teaching and in a public situation.

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December 20, 2018 at 9:24 am, Vince Montefusco said:

As a volunteer first responder and lead In-house instructor for the Santa Barbara County California Medical Reserve Corps, I’ve used the AED purchased from AED Superstore 2 times in a year. Both victims survived due to a “quick” response.

I carry my trauma kit with included AED in my travels.

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January 15, 2019 at 8:40 am, Erin H said:

I have said what Sigrid Vogelpohl suggested. Sometimes it works and sometimes it doesn’t. I am not concerned for me being recorded, but I am concerned the patient!!

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October 14, 2019 at 1:47 pm, Women Less Likely to Receive Bystander CPR During Sudden Cardiac Arrest - AED Superstore Blog said:

[…] arrest while surrounded by a large number of people, the odds of them receiving immediate care is less likely since there may be a tendency by potential rescuers to believe there is someone more qualified […]

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