Women are 27% less likely to receive bystander CPR for an out-of-hospital sudden cardiac arrest event than men. Why? There may be a very simple explanation: breasts.
The Training Manikin Problem
Most CPR training manikins come in various skin tones, with configurations ranging from preemie infants to obese adults. Unfortunately, the one thing most of them have in common is that they are all flat-chested. In fact, with the exception of one very specific manikin (the Life/Form CPARLENE), there aren’t any breasts to contend with when learning CPR. Even the original CPR manikin – Rescusci-Annie, is decidedly unendowed. We need to start the conversation about how to change our perception of appropriate and inappropriate when it comes to life-saving procedures so the outcomes are positive for all genders.
Slightly less than half the population is, for the most part, not flat-chested. In fact, many women are considerably the opposite. CPR is required for everyone who goes into sudden cardiac arrest (SCA), and yet the taboo of baring a woman’s chest in public and beginning CPR on her to save her life may sometimes cause men (and even women) to hesitate. A study of 600 participants in 18 different CPR sessions was conducted by Dr. Torben Becker of the University of Florida in Gainesville. He found that of those that were reluctant to step in and perform CPR, 14% said they were reluctant to expose a woman’s chest, and 6% said they were afraid they would be charged with sexual assault. Despite all efforts to lift that taboo by raising awareness of the importance of quality CPR and the use of an AED to treat SCA, women are less likely to receive the care they need from bystanders, which means they are statistically less likely to survive.
Proper steps for performing CPR and using an AED on women
- Determine if the person is unresponsive by tapping the person near the collar bone and shouting “Are you OK”. If they are responsive but are clearly in need of medical attention, call 911 and stay with the patient. If the person is unresponsive or not breathing normally, proceed with cardiac arrest rescue measures.
- Call 911
- Retrieve or send someone for an AED
- Remove all clothing from the patient’s chest – this includes swimsuits, bras, sports bras, tank tops, and regular tops. If you need to, you can cut through clothing with the shears included in an AED’s response kit. Be sure to cut away from the person’s face. Apply the AED electrode pads as indicated on the packaging.
- On most women, the breasts will fall to the side once clothing is removed. They will no longer be “in the way” of performing CPR and hand placement would be the same as on a man – two fingers above the bottom of the sternum, between the nipples. You may need to lift the left breast to accurately place the AED pad under it. Bras need to be cut for AED electrode pads to be placed properly.
- Some women may have smaller breasts that will not fall out of the way. As with a man, hand placement is the sternum between the nipples. Since the bottom hand fingers are extended, they may touch the woman’s breast.
- Some women may have had breast enhancement surgery wherein the breasts are more rigid, so they may be larger, but may not fall to the side. Again, hand placement is the same, the fingers will most certainly touch the woman’s breast, and CPR should be performed as accurately as possible.
- Follow the AEDs directions, performing CPR and pausing for analysis by the AED, until EMS arrives and takes over.
It’s Not Inappropriate
CPR is a life-saving action to treat sudden cardiac arrest and increase the odds that a person will survive. There is nothing inappropriate about it, and bystanders are key players in the chain of survival. Unfortunately, if someone goes into sudden cardiac 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 nearby. Being prepared for an SCA emergency means understanding it truly can happen to anyone, regardless of age, ethnicity, physical fitness, or gender. Someone in cardiac arrest is unresponsive and not breathing, or not breathing normally. For all intents and purposes, they are dead. Anything you can do to help is better than doing nothing at all. That includes removing the person’s clothing to more accurately perform CPR and correctly attach AED electrode pads. It is not time to be prudish or worry about modesty.