Why women receive less CPR from bystanders
August 22, 2022 2:28 PM   Subscribe

Why women receive less CPR from bystanders. Separate studies explore why women are less likely to receive bystander CPR. A small survey found that people may worry that chest compressions by bystanders will seem improper or may hurt women. A virtual reality study found that even female avatars were less likely to receive CPR from bystanders in a virtual simulation.
posted by carriage pulled by cassowaries (61 comments total) 23 users marked this as a favorite
 
As a woman, I've sometimes pondered this exact scenario. I totally understand the results; with modern times being as litigious as they are, and with cameras everywhere, I understand the hesitation.
posted by starscream at 2:39 PM on August 22, 2022 [2 favorites]


I train first aid which includes CPR. I know they exist because they’re in catalogues, but I’ve never used or physically seen a resuscitation (‘Annie’) dummy with noticeable breasts. And we react the way we train.
posted by Fiasco da Gama at 2:50 PM on August 22, 2022 [44 favorites]


Seems to me that based on that research, CPR marketing and advertising should advertise that rib injuries are common to all who receive manual CPR, with over 30% featuring fractured ribs and a higher percentage being stretched or strained.

I would assume that would allay the fear that women specifically are more likely to be injured by manual chest compressions.
posted by The_Vegetables at 2:53 PM on August 22, 2022 [12 favorites]


Other papers:

Public perception towards bystander cardiopulmonary resuscitation:
The leading concerns were ‘causing injury to patient’ for geriatric (n=193, 63.1%), female (n=51, 20.5%) and adolescent (n=148, 50.9%) patients. Lack of appropriate skills was the second leading concern when the victim was a geriatric (n=41, 13.4%) or adolescent (n=68, 23.4%) patient, whereas for female patients, 35 (14.1%) were concerned about exposing the patient or the patient’s breasts interfering with performance of CPR and 15 (6.0%) were concerned about being accused of sexual assault.
Gender and location disparities in prehospital bystander AED usage:
Female patients are less likely to receive bystander AED usage compared to male patients. To resolve these disparities increased public awareness is necessary that supports AED usage on females as socially acceptable and necessary for patient outcomes.
posted by zamboni at 2:53 PM on August 22, 2022 [1 favorite]


I think TV does a terrible job of giving people an idea of what CPR looks like. They're so gingerly applying the compressions even when they seem intense and determined. As said above, real chest compressions will break ribs. Imagine the heart behind all that armor and you need to somehow squeeze it externally.

I think there are two issues though - a reluctance to use the force required on a female without thinking it through "… let them be likely to die …", and secondly the breasts thing.
posted by Sunflowers Beneath the Snow at 3:10 PM on August 22, 2022 [5 favorites]


We, uh, really need to explain to people during CPR training that the ribs are gonna break, and hopefully the first person doing compressions completes that for the next folks. If you’re not pressing hard enough or deep enough to pop the ribs, you’re not providing quality compressions and you’re not restoring circulation properly. You think the way humans compress is violent? Check out a Lucas Device or an AutoPulse. We look downright dainty when we do it. We also need to dispel the myth that everyone who receives CPR or is in an originally shockable rhythm is going to survive. That ain’t the case. If it’s not a witnessed arrest, if it’s not a shockable rhythm, if people aren’t immediately on the chest, the chances of that person coming out of the hospital at all, let alone neurologically intact, are minute.
posted by sara is disenchanted at 3:12 PM on August 22, 2022 [22 favorites]


may hurt women

This disparity is appalling but I want to push back on the implication that CPR shouldn't hurt.

If you are doing chest compressions correctly, you are slamming 100+ lbs of body weight into a 3 square inch space. You WILL break ribs. If you are not breaking ribs, you are not doing it right. The person, if they are resuscitated, will feel like shit afterwards. That's because they were dead, and now they're not, and that tends to feel kinda unpleasant.

Too many people believe that CPR = three gentle pats on the chest.

Also, this thread reminded me that I'm due to renew ACLS, thank you!
posted by basalganglia at 3:14 PM on August 22, 2022 [24 favorites]


When taking a CPR course, the instructors told us that we also had to expose the chest and shave off any hair when using an AED, which seemed like a pretty significant step!

And you don't stop CPR unless someone else takes over, or you collapse from exhaustion. I think the percentage of people spontaneously coming back to life with CPR is very low. You're mostly making sure that blood is flowing through the person's brain, so when the professionals take over, they're not resuscitating a vegetable.
posted by meowzilla at 3:27 PM on August 22, 2022 [4 favorites]


I train first aid which includes CPR. I know they exist because they’re in catalogues, but I’ve never used or physically seen a resuscitation (‘Annie’) dummy with noticeable breasts. And we react the way we train.

The only time I have even seen one of those was when I sat in on an EMT class once. Every time that I've completed a CPR training (every other year these days, I think), it has been with the "generic" (i.e., male) manikins.
posted by Dip Flash at 3:30 PM on August 22, 2022 [6 favorites]


I've taken First Aid / CPR one million times, and except for Wilderness First Aid it's always been about men's heart attacks. They list the symptoms of heart attacks and then say "women's heart attacks might present differently" as if the standard is a man, and women are an aberration.

So between that and all the flat-chested CPR dummies, I'm not surprised that someone seeing a woman in need of CPR might not make the connection. We know what heart attack victims look like, and they're all clutching their chests before they pass out on the floor.
posted by The corpse in the library at 3:38 PM on August 22, 2022 [18 favorites]


That's because they were dead, and now they're not, and that tends to feel kinda unpleasant.

Better, in theory, than staying dead, tho.
posted by chavenet at 3:55 PM on August 22, 2022 [3 favorites]


Meanwhile, ICYMI, there was this lovely post just minutes ago in which successful CPR features big.
posted by chavenet at 3:57 PM on August 22, 2022 [2 favorites]


“And you don't stop CPR unless someone else takes over, or you collapse from exhaustion.”

Well, no. It’s hard and the body only has finite oxygen so you can stop earlier than collapsing. This is especially important to acknowledge in remote situations when those professionals aren’t showing up in time. And by remote I mean like 30 min down a trail.

Do CPR for as long as you can.
posted by hydrobatidae at 4:00 PM on August 22, 2022 [20 favorites]


I'll step back in with my trainer's hat on and I hope clear up some misconceptions.

1. Any attempt [to save a life] is better than no attempt [to safe a life].
2. Is the person responsive, and are they breathing? The mnemonic DRSABCD for primary assessment is a trained set of steps that apply to all first aid, in all situations, on all people, all the time. It will come back to you in the pressure of the moment, it will relieve you of thinking about irrelevancies, it will provide you with steps you must and will follow, and you will have more confidence and competence for point 1.
3. On ribs: human bones are surprisingly strong. Americans, consider the strength of a cooked pork rib: could you break one? It's more likely that the joining cartilage between ribs will suffer from effective compressions, and there'll certainly be bruising. Smaller and older people have less strong ribcages, and yes, they can all break. But who cares? See points 1. and 2.
4. Rescue dummies have a common face, and she's female, which is its own story, involving early 20thC anxieties about same-sex male kissing. But it's true that by and large, most people train on dummies which have the size-musculature of a thin young man, with a flat chest and no belly. The face and chest are supposed to be an every-patient, which is of course unsatisfactory; but at the point of rescue, it's irrelevant: why are we talking fin-de-siècle French history? Return to points 1. and 2.
5. In almost every course we do discuss the variety of human bodies, and aspects like underwire bras, and obesity, and chest hair. Defibrillators work best on clean, dry skin, but they will work. We always discuss treating the patient with dignity, and we discuss the circumstances under which you'd shave a very hairy patient or cut through clothing, but in the end, who cares? Just make it work. Always return to points 1. and 2.
6. The 'chain of survival' is the set of steps to maximally improve the patient's chances of recovery: it's early access, early compressions, early defibrillation, and early advanced care [in a hospital]. It's true, research shows that CPR without defibrillation has a very very low chance of success. On the other hand, no action at all is guaranteed to fail. Return to points 1. and 2.
7. It is true that heart attack symptoms present differently in men and women, and in all people there's a range of different signs and symptoms. The same symptoms are also present in angina (and in other things, too). On the other hand, it's a misconception that we need to be able to identify a cardiac arrest to start CPR—the mnemonic is only about unconsciousness, and breathing, and the actual medical condition is irrelevant. If someone is unconscious and not breathing? Stop wondering, and refer to points 1. and 2.

If the above seems repetitive, yes it is. The idea in training is to increase knowledge and confidence, but also to pare things down to the essentials: any attempt is better than no attempt.
posted by Fiasco da Gama at 5:16 PM on August 22, 2022 [29 favorites]


sara is disenchanted: "We also need to dispel the myth that everyone who receives CPR or is in an originally shockable rhythm is going to survive. That ain’t the case. If it’s not a witnessed arrest, if it’s not a shockable rhythm, if people aren’t immediately on the chest, the chances of that person coming out of the hospital at all, let alone neurologically intact, are minute."

Setting aside the gender disparity, I wonder if conversely the increase in this kind of knowledge reduces CPR administration rates. Like, if I saw someone who needed CPR, I feel like I would probably administer it (you never know for sure until you're actually in that situation), but the whole time I did it I'd be thinking "according to everything I've read about CPR on the internet, all that this will accomplish is that I will put the person in immense pain as I break their ribs, and they'll die anyway, but instead of dying here on the spot they'll die in the hospital several days from now after immense suffering..."

Like I said, I think I'd still do it, because I'd think "hopefully this is the miniscule X% of folks who will survive and go on to live happy lives," but that would constantly be jostling shoulders with the thought "...but odds are I'm just turning a quick, painless death into a prolonged agonizing one..."
posted by Bugbread at 5:38 PM on August 22, 2022 [6 favorites]


(Also, I realize that this is an ethical dilemma that doctors deal with every day, but it's certainly not one I deal with every day. Maybe after I've administered CPR to 3 or 4 people it won't be something I struggle with, but that first time is going to be a doozy.)
posted by Bugbread at 5:39 PM on August 22, 2022 [3 favorites]


Oh gosh!! This is real. I remember lifeguard training as a teen where the instructor managed to show us what to do and coached us that we had to do compressions harder, not to be shy. And after using the dummies, we practiced placement on each other, in pairs with his feedback, to make sure we got it right. I'm glad our trainer didn't shy away from accuracy. It felt totally appropriate and not uncomfortable, which is pretty darn impressive. After seeing this article, I'm extra glad he was so serious about it!
posted by smorgasbord at 5:53 PM on August 22, 2022 [2 favorites]


So, if we don’t get ROSC (return of spontaneous circulation) in the field, we call it after about 25-40 minutes of continuous CPR/defib/meds. If there isn’t a pulse at that point, there’s not going to be one, and everything they can do in the trauma room is the same stuff we’re doing on scene, with the added benefit of people who’ve responded to hundreds, if not thousands, of cardiac arrests. I have no idea how many codes I’ve run in over 15 years. A lot. I personally have had two (2) saves. And that’s here, where no, we’re not as progressive as Seattle, but we're pretty darn progressive from a national EMS standpoint.

We don’t expect laypeople to understand much about cardiac arrhythmias, the drugs used on a code (that’s a whole ‘mother source of argument), or Utstein rates. What they need to know is effective compression-only CPR, have someone else contact 911, and follow the automated directions from any nearby AED.

100-120 compressions a minute, 2” deep, arms straight, allow for proper recoil of the chest. If you’re not used to it, one or two cycles is going to wear you out.

The way a lot of us look at it is; I’m not making it worse. If that person was circling the drain before I got there, I can try to save them. My inaction will result in nothing positive. My action might preserve life. If it didn’t, well, it’s not my fault. That sounds callous, maybe? But I didn’t put that person in that situation. All I can do is my best to try to get them out of it. We can fix broken ribs; so far as I’m aware, we can’t fix dead (or stupid, but again, that’s another argument).

As far as the disparities in male/female symptoms, there’s theory that with women being more familiar with/accepting of pain (endo, cramps, labor, etc) they don’t always recognize that heart attack pain is just that.
posted by sara is disenchanted at 5:57 PM on August 22, 2022 [16 favorites]


[...]all that this will accomplish is that I will put the person in immense pain as I break their ribs, and they'll die anyway […]

Remember that the patient is dead and not feeling any pain, so please go ahead and do the compressions.
posted by monotreme at 6:27 PM on August 22, 2022 [15 favorites]


Everyone’s talking about ribs, and I just took an in-person certified CPR course, and they talked about ribs. But I have so many unanswered questions about the plain logistics, that I’m More Nervous to do CPR on women (and I am, now, women): exactly as the post indicated.

Will I permanently damage someone’s breasts doing CPR through them? Should I push them aside or work above them or between them? Are they going to cause my hands to slide off target if I hit the dense center zone?

I get that #1 and #2 are helpful for getting off the ground with trying to sustain a life, but there are training-absent logistical questions and dummy-absent implants and given my own uncertainty, I do not trust the general populace to save my life today.
posted by Callisto Prime at 6:32 PM on August 22, 2022


monotreme: "Remember that the patient is dead and not feeling any pain, so please go ahead and do the compressions."

I will do it, so I'm not disagreeing with you on this point, but I feel perhaps I've misphrased what I said. It's not that I think that I'll put them in pain at the time, but that they're dead and not feeling pain, and the internet has led me to believe that odds are that what I'll do is revive them to the point that they can be in immense pain for a few hours or days and then die again. Kinda like a torture scene in a movie where someone passes out and then the torturer revives them so they can feel more pain for a while.

Again, I'm not saying that "and because of that, I won't administer CPR." I will (I hope), because there are some people who do recover and do enjoy many more years of life because of CPR. It's a gamble, and I guess it's a gamble worth taking. But I wonder if this kind of first-hand discussion of what CPR and what happens after CPR dissuades anyone. Growing up in the 80s, when all you knew about CPR was what you saw on TV/movies and what you learned in a CPR class, CPR just seemed like all upside and no downside. Now, with the internet, all of a sudden you just hear horror story after horror story.
posted by Bugbread at 6:47 PM on August 22, 2022 [2 favorites]


No, no boobies will be harmed in the course of CPR. No, they don’t really get in the way. Your fingers might kind of rest near one, but I can promise you that none of this is titillating in any way, shape, or form. Trauma naked is quite distinct from sexy naked.

I mean, Bugbread, if they’re even making it to the hospital (really big IF) they will be hopped up on pain meds and stabilized. You’re not maiming them. Sometimes we even get a pulse but then they never really regain consciousness. No CPR recipient is going to be mad at someone else for performing CPR on them because either they’re DRT (or soon enough) or they’ll be alive.
posted by sara is disenchanted at 6:54 PM on August 22, 2022 [14 favorites]


I'm actually really glad for this thread, that we can discuss and clear up questions.

Callisto, if you're More Nervous now than when you did your course, your trainers have let you down! I'm sorry that you are, and please let us reassure you—if you can be the person to step forward to help, you should do that.
Will I permanently damage someone’s breasts doing CPR through them? Should I push them aside or work above them or between them?
Breasts won't get in the way, but you really may damage and bruise flesh and bone, and that's OK. Rib injury is just not relevant if a patient is unresponsive and not breathing. ANZCOR (which is the peak body in Aus/NZ where I am) is very clear in its advice: 'ANZCOR recommends that CPR is started for presumed cardiac arrest without concerns of harm to persons not in cardiac arrest'. (My italics).

The logistical question ('where?') about pressing on chests also applies to very obese bodies, too, but in the end a chest is a chest. The centre that you want to press down on should be halfway between breasts, male and female, especially when the patient is lying flat on a hard horizontal surface like the ground (which they should be, for effective CPR). It's somewhere between sternum and collar bone, and don't overthink it; compress to get air moving in and out of the lungs, and blood moving around the body.
the internet has led me to believe that odds are that what I'll do is revive them to the point that they can be in immense pain for a few hours or days and then die again
The thing about DRSABCD is that it relieves you of thinking about any of these things. Ordinary members of the community can't possibly know the answers to any of these questions, and we can only act as we'd like to be treated—for me the Golden Rule would say, if you see me lying on my back, unresponsive and not breathing, please run through DRSABCD right now.
posted by Fiasco da Gama at 7:00 PM on August 22, 2022 [4 favorites]


Broken ribs hurt. They give you opiates for it. And basically don't do anything else. No cast or anything. They heal up all on their own and you're better. It's never the most terrible thing that ever happened to anybody.

Beats a broken ankle. Or cardiac death.
posted by Sunflowers Beneath the Snow at 7:14 PM on August 22, 2022 [4 favorites]


"Will I permanently damage someone’s breasts doing CPR through them? Should I push them aside or work above them or between them?"

When you lie down on your back, your boobs attempt to slide into your armpits. So assuming you're not in an anti-gravity situation, the boobs will already be out of the way (honestly even if they're pretty large). Pictures of celebrities lying on their backs with boobs pointing skywards mostly involve undergarments or boob tape. Yes, theoretically, implants could make the boobs super-vertical in a CPR situation, but even most implanted breasts slide to the side when you lie on your back without careful posing or artificial support in the form of tape.

My spouse litigated several CPR injury cases, which virtually ALL arise from people getting CPR in prison settings from cops. "OMG HE BROKE MY RIB" gets you a giant "GTFO" from even the dumbest state court judge. CPR breaks ribs; that's just how it works. That's literally how you know it was good CPR. If your family member died in jail and the cops provided CPR and DIDN'T break any ribs, then you've got yourself a tort case. If your family member collapsed in jail and died and the cops enthusiastically broke his ribs in a CPR pattern, well, they did their damnedest to save his life and you may have other causes of action against the jail, but not for attempted CPR.

Occasionally my spouse had guardianship cases where an elderly person had their ribs broken by CPR (usually by paramedics, sometimes nurses in a care home) and it was a fact in the larger guardianship case, but nobody EVER sued about it in that situation; it was just part of a "should this person with some dementia be allowed to execute a DNR?"

Break some ribs, save a life.
posted by Eyebrows McGee at 7:20 PM on August 22, 2022 [12 favorites]


Good to know. Thanks for y'all's input.

I've taken maybe 3 or 4 CPR courses, and have an apparently amazing ability to not retain any of the knowledge that is taught to me. The last time I took a CPR class I realized that I had forgotten almost everything I learned literally by the next week. All I could remember then (and all I can remember now) is "tilt the head back/chin up" "interleave your fingers" "don't bend your elbows" and "push kinda deeply to the rhythm of 'Stayin Alive'". My AED training has stuck with me even less -- "Follow the instructions the device gives, and don't let anyone touch the person".

I know there are a ton of resources on CPR out there. Does anyone have any recommendations for resources with lots of mnemonics that stick with you? Clear instructions are great, but for me the problem isn't "understanding" but "remembering". If there's something I can latch on to (like 'Stayin Alive'), I can retain it but otherwise its gone in minutes...
posted by Bugbread at 7:29 PM on August 22, 2022 [1 favorite]


It's not a very complicated thing. Personally, I'd just prefer a person looking for a mnemonic device to just not do CPR on me, let it go, let me go. I think you can just forget it and it will be fine. It's extremely unlikely you will ever be tested. Just leave the scene I suggest, or let someone else take over.
posted by Sunflowers Beneath the Snow at 7:40 PM on August 22, 2022


I liked how in one CPR training class I took, they made a point of explaining that it was entirely plausible that you might break someone's ribs as part of doing CPR and it was absolutely a 'normal' thing that happens during CPR, but - and this was the important part - if you were looking at doing CPR on someone, that means THAT PERSON IS DEAD and really, broken ribs are a small price to pay for being not-dead..
posted by rmd1023 at 7:50 PM on August 22, 2022 [3 favorites]


I'm a 'civilian' who gave CPR to a family member when she collapsed in my home. Thankfully, luckily, amazingly, she lived.

Don't worry about remembering the details of your training. Don't worry that you'll do it wrong. The actions themselves are pretty damned simple.

The one most difficult thing, the biggest hurdle, is realizing that YES this is actually happening, and YES this is the emergency, and it is TIME TO DO THE THING. There's a mental and emotional threshold between everyday life and emergency action. Getting yourself over that threshold quickly is the hard and important part.

Also, keep an AED in your house and workplace! All this CPR is just trying to minimize brain damage til they can shock the person to try to restore some kind of heartbeat. Way better if you can start the shocks sooner too.

Oh also: the "not breathing" part of that training acronym: they don't emphasize enough "not breathing NORMALLY". People in cardiac arrest can exhibit agonal breathing, which is a body's reflexive gasp for air, and is terrible to witness, and is not, effectively, breathing. If they're doing that, yeah, start CPR.
posted by hovey at 8:49 PM on August 22, 2022 [23 favorites]


The aunt who's the closest thing that I have now to a mom was revived by CPR at a Unitarian-Universalist mass or whatever they call their service; one person--one--at the service both knew CPR and was willing to risk cracked ribs or possibly touching a boob or whatever. That's why I'm still making plans for Thanksgiving with her, over thirty years later. "Stayin' Alive" or "Another One Bites the Dust", both super-ironic (and easy to remember) song titles for the rhythm to maintain. Just, please, do the thing.
posted by Halloween Jack at 8:54 PM on August 22, 2022 [14 favorites]


Thanks all for the assurances, it does indeed help. The CPR training did fine at teaching me the practice of it, but I’m glad the fount of new questions is gone away too. Note to self: CPR is closed-heart surgery, in a sense, and inflicting bruising and broken ribs is not a consequence; it’s a necessity.
posted by Callisto Prime at 9:48 PM on August 22, 2022 [4 favorites]


(Also, I don’t intend to slight anyone by my fear of the general human public, I’ve just had to face multiple “a lot of women die from the bystander problem” posts this week and my faith in humanity is pretty diminished. I assure all of you that sought any knowledge at all that I’m grateful, even if I hope never to have cause to use it.)
posted by Callisto Prime at 9:53 PM on August 22, 2022 [2 favorites]


"Personally, I'd just prefer a person looking for a mnemonic device to just not do CPR on me, let it go, let me go."

I don't want to be a noodge, however --

My second child stopped breathing when we were on a hike, when he was 18 months old. My older son was 3 1/2. I rolled my 18-month-old over on the path where he'd collapsed and attempted to find an pulse. I COULD NOT. I attempted to blow rescue breaths into his lungs. I FAILED. I didn't remember how to position the head to get breaths into the lungs. I panicked, scooped him up, told my 3-year-old to follow me, and started running for the trailhead. I called 911 while running. The 911 operator took my info, and listened to me gasping, and said, "Maybe you should stay where you are, we can get to you." I said, "NO!" and kept running. We passed a random dude on the trail. I shouted to him, "MY BABY ISN'T BREATHING, BRING MY TODDLER TO THE TRAILHEAD!" because I was starting to outdistance my 3-year-old. I JUST RAN AND HOPED FOR THE BEST.

I dashed into the trailhead building, barely breathing because I was not in shape, and shouted, "MY BABY ISN'T BREATHING!"

I will literally never forget how the woman staffing the nature center RAN out from the counter and skidded on her knees to my baby, pulling gloves on as she went. She competently felt for a pulse and got a breath in his lungs. 90 seconds after I called -- 30 seconds after I arrived at the trailhead -- paramedics arrived from my 911 call. By then, my baby was already starting to rouse from the competent CPR of the nature center staffer, and they had him fully awake and SCREAMING HIS HEAD OFF in 2 minutes. My toddler wandered in slightly later, with the random trail guy, who was clearly embarrassed and trying to escape. The other nature center employees let him play with a tarantula (as one does).

My baby went in an ambulance to the ER. We could not raise my husband by phone, and had to call a friend of ours who worked a couple buildings over to go and bang on the door of his meeting and say DUDE CALL YOUR WIFE NOW. My neighbor watched my toddler so I could go to the ER. A gerontologist doctor friend of mine met me in the ER because everything was terrifying. Everybody at the nature center cried. I cried.

Half an hour later, when I was sitting with my 18-month-old in the ER giving him apple juice, my phone suddenly announced, "Congratulations. You have a -- new -- personal best -- time -- for one mile." NO FUCKING SHIT, FITNESS TRACKER APP.

ANYWAY, I signed up for the very next pediatric CPR class that the Red Cross offered in my area, and I've re-upped my pediatric First Aid/CPR/AED regularly ever since. I can literally never repay the nature center employees or paramedics who knew what to do when my baby stopped breathing, so I am goddamned determined that if anyone at all stops breathing in front of me, I will fucking know what to do. I will NEVER again be unable to find an airway on a hiking trail. I will break the fucking ribs of anybody who stops breathing in front of me. It's my goddamned duty, and I will NEVER be unprepared for it again.

DO CPR TRAINING. Save a toddler's life.
posted by Eyebrows McGee at 9:58 PM on August 22, 2022 [112 favorites]


assuming you're not in an anti-gravity situation

Assuming you are in a zero-gravity situation, these guidelines from the European Society of Aerospace Medicine provide some of the best available advice on how to perform CPR in space.

It's an interesting read, covering a wide range of medical, ethical and technological issues. Apparently the literature is divided on technique. Should you strap yourself to the patient? Should you do CPR from behind like a Heimlich maneuver? Grapple the patient with your legs like a spider? Do a handstand while pushing the patient into the wall on the far side of the capsule? Advantages and disadvantages...
posted by justsomebodythatyouusedtoknow at 10:46 PM on August 22, 2022 [9 favorites]


Just discussing this at dinner last night, = point 7 by Fiasco: the symptoms of heart attacks differ between typical women and men.
Unique symptoms for women [½ of whom have no chest-pain] include:
- Fatigue, often the first and most unrecognized symptom
- Back pain between the shoulder blades
Unique symptoms for men include:
- Pain in one or both arms
- Back or stomach pain
- Abdominal discomfort that may feel like indigestion
posted by BobTheScientist at 11:14 PM on August 22, 2022 [1 favorite]


Should you do CPR from behind like a Heimlich maneuver? Grapple the patient with your legs like a spider? Do a handstand while pushing the patient into the wall on the far side of the capsule? Advantages and disadvantages

Obviously, you go for your knife and/or your bone saw, cut your way into there and go straight to open cardiac massage which won't impart any forces on the body as a whole. Or the behind-the-person extreme rib-busting hugging seems reasonable especially if the habitat is large and you have the upper body strength. Probably need to make a fist with one hand and use the dominant strongest arm laid over it to squeeze like hell over and over.

Thanks for the link.
posted by Sunflowers Beneath the Snow at 11:33 PM on August 22, 2022


Nine-year-old Gold Coast girl saves mum's life with help of triple-0 dispatcher

This is a lovely story of CPR being done by a nine year old!
posted by freethefeet at 3:20 AM on August 23, 2022 [2 favorites]


Broken ribs hurt. They give you opiates for it

I broke ribs in a running slip and fall on Dec 30,2021 capping off a really shitty year in fine fashion. It was the height of omicron so I didn't even see a doctor. No opiates and just a lot of ibuprofen. It was awful for about a month and took about 4 months for me to get back to the gym and 6 months total for it to fully heal.

Broken ribs were an ordeal but I have to say I still really enjoy being alive and even enjoyed being alive while my ribs hurt. Ribs heal.

If you can try and save a life you should give it a go! I can't imagine the pain you'd inflict on your own psyche if you didn't even try.
posted by srboisvert at 3:26 AM on August 23, 2022 [5 favorites]


An interesting thread. I think I'd jump in regardless of the gender / identity of the person, only because I've done it before in other situations.

However, the idea of touching a female's chest area without permission feels so fundamentally wrong. And now it has been raised, it would definitely be on my mind. So, thanks for unlocking that new fear.

And for those who have done the course several times like i have, it will quickly go from your head without regular practice - like any habit/technique. :)
posted by greenhornet at 6:32 AM on August 23, 2022 [1 favorite]


Well, this very informative thread convinced me to finally sign up for my local Red Cross's next civilian first aid course. Looks like they offer regular refresher classes, too, which I will absolutely be doing.
(PS: if I ever need CPR I give anyone and everyone who might attempt it permission to bruise my boobs/ruin my underwire garments/break my small lady-ribs)
posted by peakes at 8:24 AM on August 23, 2022 [5 favorites]


PS: if I ever need CPR I give anyone and everyone who might attempt it permission to bruise my boobs/ruin my underwire garments/break my small lady-ribs

Yes, I would much rather

- have my clothing cut open
- let the whole street see my breasts
- have a stranger put their hands on my chest
- have a broken rib

than DIE.

Dying is pretty much the worst possible outcome!

CPR if I need it, please! ^_^
posted by carriage pulled by cassowaries at 8:41 AM on August 23, 2022 [9 favorites]


However, the idea of touching a female's chest area without permission feels so fundamentally wrong.

I have attended an all-day CPR training session, and as an unmarried male with little experience (then) I would have welcomed a little training with this specific category of victim. I would suggest augmenting the training with some practice yanking open blouses and cutting away foundation garments, so in an actual emergency situation it's not the first time (because if it is, embarrassed hesitation could delay action).
posted by Rash at 9:05 AM on August 23, 2022 [2 favorites]


I am a civilian who unfortunately had to perform CPR on a woman who did not survive a medical emergency which occurred on trail, one year ago this month.

I just don’t think the results of that survey, in which only 3/10 respondents were CPR certified, are meaningful (who knows if any of those people ever had to use the certification). It’s impossible to know what you’ll do in a life or death situation unless you’re faced with it. I was certified for years for work before I had to use CPR and I honestly didn’t think I would know what to do but it was like an out of body experience and thankfully my training just…took over.

FWIW, breasts move themselves out of the way for the most part when one is in a prone position.

Please, if you’re not CPR certified, in memory of L, who was by all accounts a brilliant, loving, and compassionate person, consider doing so. I hope you’ll never have to know what it’s like to use the training, but if you do you may be surprised that all the things you think you’ll worry about when it happens are trumped by the urge to do anything you can to save a life.
posted by sparringnarwhal at 9:55 AM on August 23, 2022 [18 favorites]


If you don't have an AED, you don't need to expose the chest. Use landmarks from your training, push hard, push fast. You only need to expose the chest when an AED arrives and the person who brings it can (and should) work around you to do that so that compressions are minimally interrupted.
posted by Pantengliopoli at 9:58 AM on August 23, 2022 [8 favorites]


Assuming you are in a zero-gravity situation

Medlife Crisis (the YouTube channel of Dr. Rohin Francis) has a video in which he tested various possible methods of doing CPR in zero gravity.
posted by Lexica at 11:41 AM on August 23, 2022 [2 favorites]


> practice yanking open blouses and cutting away foundation garments

Yanking open a blouse is the same as yanking open any other shirt, and not needed for CPR anyway. I can speak only to the unmentionables I myself wear, but there'd be no need to cut them off -- they're not the industrial girdles of 1940s cartoons.
posted by The corpse in the library at 1:19 PM on August 23, 2022 [5 favorites]


Also, if anyone is curious, yes, infant CPR may crack their springy little ribs. Don't stop if you hear or feel that. But do be aware of how to do infant CPR.
posted by Sunflowers Beneath the Snow at 4:04 PM on August 23, 2022


Infant CPR isn't super complicated.

For a baby, place both your thumbs (side-by-side) on the center of the baby’s chest, just below their nipple line
  • Use your other fingers to circle the baby’s chest around their back to provide support
  • Use both hands' thumbs at the same time, and push hard down and fast about 1.5 inches, approximately 110 per minute. Like two squeezes per second.
  • Let the chest to return to its normal position after each double-thumb-squeezed compression
Do 30 compressions and then 2 breaths, and repeat. For the breaths, tilt their little head to open the airway, puff a little air into their lungs: cover their tiny mouth and tiny nose with your huge mouth and inflate them. It doesn't take a lot of air.
posted by Sunflowers Beneath the Snow at 4:13 PM on August 23, 2022


That 30 and 2 thing and 100-120bpm part is the same for adults as it is infants. The real difference is just gentle breaths for the infants and you don't need to smash the infant into the pavement with the compressions.

You may find some guidance which will actually tell you not to do the breaths at all: go with that if it makes you more comfortable or don't. That is really basically some harm reduction galaxy brain way of trying to increase the likelihood any intervention is done at all, because some people feel some type of way about the breaths or it's hard to remember how often to alternate. Long story short, it is better to give the breaths; but it's better to do the compressions without breaths than it is to do nothing at all.
posted by Sunflowers Beneath the Snow at 5:06 PM on August 23, 2022 [2 favorites]


Last time I had the training the only circonstance I was told it was important to include breaths was when a drowning was suspected. I was taking it to get my rescue diver certification, so it was very à propos.
posted by WaterAndPixels at 6:41 PM on August 23, 2022


Sunflowers Beneath the Snow: "You may find some guidance which will actually tell you not to do the breaths at all...That is really basically some harm reduction galaxy brain way of trying to increase the likelihood any intervention is done at all, because some people feel some type of way about the breaths or it's hard to remember how often to alternate."

Thank you! At the last CPR training I went to, they were recommending not to perform mouth-to-mouth resuscitation, but I just couldn't get an answer about why not. After they gave two really vague answers I didn't press anymore because I didn't want to bring the class to a halt, but I was always curious about that.
posted by Bugbread at 6:44 PM on August 23, 2022 [1 favorite]


Hands-only CPR is a newish thing, and I think kinda a mistake at least for trainable people. But maybe they figured out something and it's really net-good given what actually occurs on the street usually. I don't know.
posted by Sunflowers Beneath the Snow at 7:24 PM on August 23, 2022 [1 favorite]


Holy Jesus Eyebrows. Like the number of insane stories you have to share is just unfathomable for one mere mortals lifetime.

I learned CPR and how to use a defrib for my friend who died of a cardiac event in his early 30s at the mall on his lunch break and I truly believe he would have had a chance if there had been a defrib there (this was before it was much more standard).
posted by St. Peepsburg at 8:23 PM on August 23, 2022 [1 favorite]


My first aid course had us perform interventions (obviously not CPR, but eg femoral artery pressure) on each other and the instructor kinda quietly set us up so that everyone would end up practicing with someone of the opposite sex at some point. I suspect that desensitization was exactly the aim.
posted by I claim sanctuary at 11:12 PM on August 23, 2022 [3 favorites]


Hands only CPR is, in part, an attempt to encourage more people to get on the chest. Early chest compressions help circulate still-oxygenated blood to the brain and heart and allow time for professional rescuers to get on scene with less tissue damage.

The oxygen in the blood will eventually get low enough that airway work needs to be part of the equation, but willingness to provide breaths mouth to mouth is a significant barrier to bystander CPR. It's also, without a pocket mask, the most risk for the rescuer.
posted by Pantengliopoli at 2:02 AM on August 24, 2022 [3 favorites]


Learn 1st Aid. Learn CPR. If you swim, learn water rescue. Helping a person live is an amazing gift. Being helped to live is an amazing gift. Yeah, my Dad got his ribs broken and died anyway, but I'm so glad they tried.

People are less likely to try to save women. Yeah, that tracks. Pretty sure some part of it is that women are valued less. We can change things if we try.
posted by theora55 at 9:43 AM on August 24, 2022 [2 favorites]


Yep, teenage life guard, I would hulk smash crush as needed.

I think the breathing thing started going out with the advent of AIDS/HIV when that bodily fluid contact could be a death sentence. I have many stories about the late 80's that involve the "it's not safe to exchange body fluids now".

I should probably take a refresher because my training was like two finger widths up from the bottom of the sternum.

I would only not because ICU nurse mother and lot's of childhood watching M*A*S*H and doctors and triage and other injuries that would reach the no practical realistic way I could keep you alive until help arrives and just being a friendly soul for a few minutes.
posted by zengargoyle at 2:13 PM on August 24, 2022


I think the breathing thing started going out with the advent of AIDS/HIV when that bodily fluid contact could be a death sentence.

You can't get HIV from saliva. (I know there was a lot of stigma in the 1980s -- still is today -- and plenty of people thought that was true, but it's not.)

Hands only CPR started in 2008, just because people are squicky about the "kiss of life" and hands only CPR is better than none at all.

Best of all is an AED (if you have a shockable rhythm). That's why Step 1 is always "You in the green shirt, call 911 and get an AED" (always identify a specific person. If you say "someone" you'll get no one.)
posted by basalganglia at 2:30 AM on August 25, 2022 [5 favorites]


Hey you with the tired looking plain face
posted by Sunflowers Beneath the Snow at 7:07 PM on August 25, 2022


"Hands only CPR started in 2008, just because people are squicky about the "kiss of life" and hands only CPR is better than none at all."

You can also get this teeny little CPR kit from the Red Cross that has a face shield mask and non-latex gloves. (I feel like the gloves are the more important safety equipment than the mask, but whatever, it has both.) It's the size of a card wallet. I carry one in my purse at all times, and can tuck it in my back pocket. I also have a few bandaids, two antiseptic wipes, and packet of neosporin tucked inside it -- one way I manage my anxiety is by being massively overprepared. I've never needed the gloves or mask so far, but all the time I am the hero of the playground for having a bandaid and antiseptic wipes.

(One time we were on a hike and one of my kids fell and scraped up his knee and my husband started panicking because we were far from any buildings and he wanted to disinfect and bandage the scrape -- he's super weird about scraped knees -- and I pulled out my CPR kit with the bandaids and alcohol wipes and neosporin and he was like ... "why are you carrying a first aid kit in your pocket?" and I was like, "Have you even met me???")
posted by Eyebrows McGee at 7:55 PM on August 25, 2022 [2 favorites]


I just did a CPR training, and while we still had only flat-chested dummies, I was pleased that the instructor spent a lot of time discussing how heart attacks show up in women and in men, and how women on average take three days to tell anyone about their symptoms, and told some relevant stories. It was the best class I've taken so far in terms of getting the balance right, and I've taken CPR from some organizations that really should know better. Even one of the classes I took through Girl Scouts, with a woman teaching it, to a class that was entirely women, did a lousy job.

So, if you're in the Seattle area and want to take a First Aid / CPR / AED class that is better than most, send me a memail.
posted by The corpse in the library at 8:41 PM on September 8, 2022 [1 favorite]


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