Women less likely to receive bystander defibrillation than men

February 11, 2024 1:48 AM

Women less likely to receive bystander defibrillation than men during a heart attack, study finds. A study of tens of thousands of Victorian cases finds women in cardiac arrest are only half as likely as men to receive defibrillation from a bystander — some telling investigators they feared exposing the patient's chest. (Previously: women less likely to receive CPR from bystanders.)
posted by chariot pulled by cassowaries (26 comments total)

I think I speak for most women who aren't ultramodest for religious reasons when I say that I would rather all 8 billion people on the planet saw my breasts if the alternative is

a) me being dead; or

b) me having severe brain damage because my brain went without blood/oxygen for too many minutes.
posted by chariot pulled by cassowaries at 1:52 AM on February 11 [58 favorites]

I remember from military first aid training, you have to check a patient for bleeding, and the crotch has a lot of blood vessels, but it's always hesitation in properly checking that area, at least early on in training.
posted by Harald74 at 2:26 AM on February 11 [2 favorites]

Another great example of a double-take from a summary that uses "Victorian" not to mean "lived during the reign of Queen Victoria" but rather "lives in the Australian state named after Queen Victoria".
posted by rum-soaked space hobo at 2:58 AM on February 11 [40 favorites]

Just when you think living in a sexually prude and “puritan” society couldn’t get worse, we now have this
posted by knownassociate at 5:01 AM on February 11 [8 favorites]

I don't think an instinct to avoid groping or exposing the boobs of strangers can be fairly categorised as "prudish".
posted by quacks like a duck at 5:35 AM on February 11 [18 favorites]

Yes, individual wishes don't negate the existence of societal biases. The one situation I've been in like this out in public, multiple women rushed in to form a shield and preserve the modesty of the potentially-injured woman (which, you know, understandable -- cameras are everywhere, and so are creeps). I clearly wasn't better prepared to render aid in that moment, anyway, so I moved on, but I'm not sure how welcome my aid would have been if I had been the most competent person on scene.
posted by cupcakeninja at 5:50 AM on February 11 [2 favorites]

Just when you think living in a sexually prude and “puritan” society couldn’t get worse, we now have this

...you know this study was in Australia, right?
posted by NotMyselfRightNow at 6:16 AM on February 11 [7 favorites]

Good Samaritan Law (Wikipedia) covers Australia. It should also be noted that CPR will often result in cracked ribs or injury and was a driver in leading to these laws.
posted by Brian B. at 6:56 AM on February 11 [4 favorites]

It should also be noted that CPR will often result in cracked ribs or injury

Also worth noting: CPR rarely works, and is massively traumatic for everyone involved.
posted by not just everyday big moggies at 9:47 AM on February 11 [7 favorites]

CPR rarely works, and is massively traumatic for everyone involved.

That's an overstatement (if you look at the article's own stats, bystander CPR in out-of-hospital cardiac arrest increases survival rates by somewhere around 30%). The problem is that the base survival rate is low and only gets lower as the patient becomes older/more infirm. CPR isn't a magic spell to solve what is an extremely dire problem, and experiencing CPR isn't a great way to exit this life. So, yes, as with pretty much every invasive medical intervention, it would be to almost everyone's benefit as they get old and frail to consider whether they want CPR, especially as they get into their 80s. But if you don't perform CPR on a teenager rescued from the water, you are significantly reducing what is already a low chance of survival.

Also, defib isn't CPR.
posted by praemunire at 10:17 AM on February 11 [22 favorites]

But people who are indignant about this finding should ask themselves how often they walk by a person apparently unconscious on a sidewalk. Most Western societies have some degree of prohibition of interfering with another person's body. My Narcan training had a section asking us to think about how we'd get over that, and Narcan is just a nasal spray.
posted by praemunire at 10:22 AM on February 11 [12 favorites]

I teach Stop the Bleed training and I always say the hardest part, that I can in no way train people for, is the willingness to interfere. Cultural norms of so many flavors come into play. Learning that 'on/off' switch to do medical work is part of having the job, and it still feels weird *right after* the times I've switched 'on' while outside hospital.
Frankly it's surprising any bystander CPR occurs.
posted by cobaltnine at 10:51 AM on February 11 [23 favorites]

But people who are indignant about this finding should ask themselves how often they walk by a person apparently unconscious on a sidewalk. Most Western societies have some degree of prohibition of interfering with another person's body. My Narcan training had a section asking us to think about how we'd get over that, and Narcan is just a nasal spray.

literally never, because i don't live in a hellscape
posted by Sebmojo at 12:54 PM on February 11 [3 favorites]

OK, check with the Maori and get back with me on that.
posted by praemunire at 1:01 PM on February 11 [2 favorites]

I think some of the hesitation comes from not knowing what to do. I have tsken CPR classes more than once to keep refreshed and never were the differences in where and how to put your hands when necessary in giving chest compressions to a woman ever addressed. Which are well, duh obvious if you think about it. But it is hard to reflect and come up with this on one's own in a crisis. The purpose of training is so you don't have to think about it, you know what do and do it. Upon exploring this topic just now, I see that the differences in how to give chest compressions to women are now being taught and female thoracic manikins are available. These sure as Hell weren't used and these details weren't being taught when I took my courses. I should hope that these differences being addressed nowadays. Sadly, I suspect it may be otherwise.
posted by y2karl at 1:06 PM on February 11 [14 favorites]

I can imagine that even regardless of differences in how you actually do CPR for people with breasts versus without, simply having diverse manikins would help accustom people to the idea of doing CPR on diverse bodies.
posted by Kutsuwamushi at 1:10 PM on February 11 [16 favorites]

I remember from military first aid training, you have to check a patient for bleeding

Aside: this is fascinating; it is absolutely true, since there’s little point in beginning CPR/defibrillation if a person is going to bleed out, but the only two groups of people I’ve encountered who actually train this way (check for bullet holes!) are former soldiers and Americans. Otherwise it’s DRSABCD.

Not aside: In the other thread cassowaries linked to I am in the comments making the point about CPR ‘Annie’ dummies used for training. Annie is an ‘everyperson’, they’re pretty universally the same smallish, pale white, hairless, thin, breastless, armless and legless torso that looks relatively fit, muscular, and young—or in other words like very very few people experiencing cardiac arrest. Training is partly about desensitisation to stress, so that we remain confident in the moment when we’re needed, and expanding that training experience to [gestures out the window] the rest of the population’s bodies, encompassing the old, various genders, fat people, very thin people, hairy people, every skin colour, people with obvious injuries, and so on is an exercise in imagination. I try to reinforce that when I train, to varying effect I guess.

I don’t think even the best resourced training organisation can possibly have a dummy inventory that reflects the actual body variety in society, or even close. But I think we can do better.
posted by Fiasco da Gama at 1:45 PM on February 11 [13 favorites]

Early CPR is encouraged and most of the checks have been done away with in order to expediate compressions, which is great, but in my first hand experience from many years working in emergency departments across multiple hospitals this results in many people getting CPR who probably didn't need it. A lot of drunk people get brought in post CPR from their drunk friends with them cheering about having saved their lives, meanwhile they were just really passed out.

I often wonder how much that skews statistics towards effective CPR working.
posted by Silentgoldfish at 4:05 PM on February 11 [4 favorites]

literally never, because i don't live in a hellscape

Sebmojo, that's fascinating and wonderful to me, because I sometimes wonder if I am one of vanishingly few people in my neighborhood willing to loudly ask a homeless person if they're okay, let alone roll an unconscious and apparently apneic/agonal homeless person over to do a sternal rub after they don't respond (and later CPR, at the instruction of the 911 operator, which the medics told me saved his life, but I found the entire thing really, really sad and scary and now I fucking carry Narcan and a pocket mask on me wherever I go because that probably would have helped that guy way more with way less chance of breaking his ribs than doing CPR to keep his heart beating while EMS was on their way)
posted by cnidaria at 8:42 PM on February 11 [5 favorites]

In my CPR class, taken in solidarity for someone who was legally required to, I asked plainly and out loud if the techniques varied in the presence of breasts. The instructor responded “no, they’re out of the way when on their back like this” and demonstrated as best they could on the default-male dummy for the rest of the class. So at least there’s twenty people out there now who have thought it through ahead of time for thirty seconds each. One small step, etc.
posted by Callisto Prime at 10:27 AM on February 12 [9 favorites]

The existence of breasts has at least been talked about in the last couple of classes I've done, which were in Victoria, FWIW.

Diversity of body shape and condition were not though and I have a vague suspicion a defib machine on my own chest would result in a flaming pyre of grey hair.
posted by deadwax at 12:45 PM on February 12 [1 favorite]

In my EMT days, many years ago, in the days of the ancient analog 12 wire EKGs and the horribly dangerous manual defib machines, one of my team members got into a lot of trouble for ripping through a young lady's top and bra and attaching the pads, etc. and then defibbing the patient.

Notice that the result is that the patient transitioned from dead to not dead.

The patient's mother took exception to the way her daughter had been treated and sued the hell out of my buddy. She didn't win, because he had followed protocol exactly. However, it sure cast a pall on the entire scene. Anyway, the stigma is real as far as I can tell.
posted by pdoege at 2:45 PM on February 12 [4 favorites]

flaming pyre of grey hair

Another good user name is provided.
posted by y2karl at 6:30 PM on February 12 [5 favorites]

Happy to be of service.
posted by deadwax at 1:43 AM on February 13 [1 favorite]

> never were the differences in where and how to put your hands when necessary in giving chest compressions to a woman ever addressed

There are no differences. It's the middle of the chest, the same place you'd put your hands when giving chest compressions to a man.
posted by The corpse in the library at 12:44 PM on February 13 [2 favorites]

The instructor responded “no, they’re out of the way when on their back like this” and demonstrated as best they could

Excellent!
posted by brainwane at 11:43 AM on March 1