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Study Suggests Women Less Likely to Get CPR From Bystanders
Women are less likely than men to get CPR from a bystander and more likely to die, a new study suggests, and researchers think reluctance to touch a woman's chest might be one reason.
Only 39 percent of women suffering cardiac arrest in a public place were given CPR versus 45 percent of men, and men were 23 percent more likely to survive, the study found. It involved nearly 20,000 cases around the country and is the first to examine gender differences in receiving heart help from the public versus professional responders.
"It can be kind of daunting thinking about pushing hard and fast on the center of a woman's chest" and some people may fear they are hurting her, said Audrey Blewer, a University of Pennsylvania researcher who led the study. Rescuers also may worry about moving a woman's clothing to get better access, or touching breasts to do CPR, but doing it properly "shouldn't entail that," said another study leader, U Penn's Dr. Benjamin Abella. "You put your hands on the sternum, which is the middle of the chest. In theory, you're touching in between the breasts."
The study was discussed Sunday at an American Heart Association conference in Anaheim.
Get touchy and save women's lives.
Also at Penn Medicine and the American Heart Association. Journal of the American College of Cardiology.
Other study mentioned in the AP article: Sexual Activity as a Trigger for Sudden Cardiac Arrest (DOI: 10.1016/j.jacc.2017.09.025) (DX)
Related study: Sex-Based Disparities in Incidence, Treatment, and Outcomes of Cardiac Arrest in the United States, 2003-2012. (DOI: 10.1161/JAHA.116.003704) (DX)
(Score: 1, Interesting) by Anonymous Coward on Tuesday November 14 2017, @10:31PM (11 children)
(directed at all commenter's who seemingly advocate for guessing what CPR is from films and doing that to a real person, while potentially obstructing someone who could actually help and therefore pretty-much killing the person yourself)
I wouldn't trust my intuition for physiology or statistics, which I know barely anything about, with my life. Hell, I don't even know if physiology is the right word for questions of the how-much-force-does-it-take-to-break-a-rib and how-do-I-not-puncture-a-lung nature.
I generally avoid any small-but-catastrophic risk without calm and relaxed consideration establishing with high enough confidence that it is reasonable to believe its a small enough risk to offset the catastrophic effect. The required standard of confidence is far higher than you may expect because I have to account for the odds I get my crude stats (which I know fuck all about) wrong.
So yes, it is worth it unless one has high enough confidence in one's estimate of the risk.
Here are some unknowns which worry me enough to stay my hand and watch a person die:
I can't perform CPR, therefore I would be mimicking the same TV shows which tell me defibrillators start hearts and gunshots knock people off their feet (which I don't watch, and so have an even less accurate view of their probably-already-inaccurate depiction).
I can't remember ever seeing a CPR scene in my life, though presumably I did since I think it's something about compressing the heart manually and I must have gotten that idea somewhere.
I haven't got a clue what proportion of CPR patients who have ribs broken and try to sue is.
I don't know how likely I am to break a persons ribs for a given force* (having never been trained for CPR, or broken a rib with my hands).
I don't know how likely slamming both clasped hands into someone's chest from above and behind my head is to do more harm than good, nor if this is overkill for CPR (though since average women can presumably do it (and maybe they can't or have different techniques, no idea) it may be overkill, or it may simply be more effective. If the ribcage can take those huge fat people from documentaries sleeping on it, pumping the heart manually probably takes a whole fuckton of force to sufficiently deform the ribcage until it forces the heart flatter and I haven't a clue how easily ribcages can be deformed to be more flat, but since its bone it I expect it would be quite difficult, unless the ribs are linked to the spine by something flexible and I'm just causing massive damage).
I don't know whether to continue CPR if they start screaming in agony.
I don't know whether to continue CPR if I break a rib.
I don't know fucking anything, and would probably do WAY more harm than a jury would overlook.
I've served on a jury in the UK and my prior unconsidered-but-it-probably-works-ok attitude to the legal system evaporated and I now have zero trust in our courts.
Therefore yes, I'd let them die in most cases because it's a huge mudball of catastrophic and unknown risk which may well end in my slowly, painfully, unnecessarily, and most importantly maybe-in-a-way-entailing-liability-for-their-death** killing someone.
The choice isn't CPR or no CPR, the choice is CPR or mimicking half-remembered television scenes from childhood which I may have entirely imagined anyway.
tl;dr: My utter ignorance of physiology may well kill the person, and I won't risk the legal, social, and mental consequences of slowly and painfully killing someone because of half-remembered advice that most people don't push anywhere near hard enough which I may have in fact imagined since I don't recall the source. It would be wholly irresponsible for me to even attempt CPR with so sketchy an idea of what it even it.
* Except the lower bound I can put on it from sleeping atop my ribcage, but hey, maybe the sternum doesn't take that force and it's something else.
** I am utterly ignorant of the laws regarding this.
/panic
(Score: 4, Interesting) by inertnet on Tuesday November 14 2017, @11:06PM (3 children)
That's a long story and you don't have time to go over it when the time comes. It comes down to this: watch someone die for sure, or try to save them instead. Now think about how you would reflect on that choice afterwards. Personally I couldn't just watch people die and do nothing, because I would be regretting that choice for the rest of my life. But I admit that I would wait a few seconds to see if someone more knowledgeable than me steps forward first.
(Score: 0) by Anonymous Coward on Tuesday November 14 2017, @11:19PM (2 children)
Faced with a mudball of catastrophic risk I don't even know how to begin assessing, I step aside and shall almost every time.
If it comes to it, I will watch strangers die and risk killing/disabling/torturing my close friends and family.
>Now think about how you would reflect on that choice afterwards.
I find my imagined decision the correct one. I'm willing to risk torturing/killing/disabling a stranger (on the assumption (from the general tone of which CPR is spoken of in) that in circumstances requiring it they are likely to die anyway), but I'm not willing to take the legal and social risks of being known to have done so, or the mental risk of it going wrong, which would weigh VASTLY heavier on me than standing aside.
>I would be regretting that choice for the rest of my life
This is the preferred outcome in terms of expected value, since the alternative is living with torturing/disabling/killing the person multiplied by the incredibly-vauge-and-overestimated odds of it happening, which would be far worse than living with inaction.
(Score: 1) by khallow on Wednesday November 15 2017, @12:32AM (1 child)
That's why CPR training is so important. While I don't expect everyone to train for CPR, you should at least be familiar with first aid so that you can do something other than step aside when someone's life is at stake.
(Score: 0) by Anonymous Coward on Wednesday November 15 2017, @04:13AM
isostatic changed my position on what I'd do in this scenario BTW, by pointing out what CPR is and that it isn't very risky. It turns out my ignorance of what it was led to quite a distorted view informed pretty much exclusively by one or two vaguly-remembered-but-maybe-imagined scenes from film/tv/something where people were hugely over-dramatic.
(Score: 2) by isostatic on Tuesday November 14 2017, @11:44PM (3 children)
I can't perform CPR, therefore I would be mimicking the same TV shows which tell me defibrillators start hearts and gunshots knock people off their feet (which I don't watch, and so have an even less accurate view of their probably-already-inaccurate depiction).
I can't remember ever seeing a CPR scene in my life, though presumably I did since I think it's something about compressing the heart manually and I must have gotten that idea somewhere.
https://www.youtube.com/watch?v=tD2qTmDsiHk [youtube.com]
I haven't got a clue what proportion of CPR patients who have ribs broken and try to sue is.
Zero.
I don't know how likely I am to break a persons ribs for a given force* (having never been trained for CPR, or broken a rib with my hands).
Very unlikely, unless it's a child and you are drunk. You're far more likely to be tickling them. If they aren't screaming in agony and you're breaking their ribs then it's almost certain they need CPR to live. What good is a pair of non-broken ribs if you are dead. If someone needs CPR, THEY ARE DEAD. The worst you can do is kill yourself as well.
I don't know how likely slamming both clasped hands into someone's chest from above and behind my head is to do more harm than good
Yes it is. Well it won't do anything. perform CPR, not kung fu or whatever that is
I don't know whether to continue CPR if they start screaming in agony.
Then they are conscious and they don't need CPR
I don't know whether to continue CPR if I break a rib.
If they aren't breathing, and nobody else is better qualified, yes.
I don't know fucking anything, and would probably do WAY more harm than a jury would overlook.
No you wouldn't. You're far more likely to do nothing and let someone die. Best bet is to take a 2 hour first aid course though, you never know when you'll need it.
Unless your idea of CPR is using a sledgehammer to smash their brains in, you are protected in pretty much any country you can think of.
(Score: 0) by Anonymous Coward on Wednesday November 15 2017, @01:43AM (2 children)
Thanks for the information.
>https://www.youtube.com/watch?v=tD2qTmDsiH
My prior image of CPR was exerting the absolute most force I was capable of on their sternum with my hands (lift clasped fists up above head, slam down as hard as I can over as long an arc as I can to maximize the time they accelerate) at a normal heartbeat pace between impacts, this is now clearly incredibly wrong and probably would do massive damage if I'd ever done it to somebody (which I almost never would have for the above-stated reasons). I HUGELY overestimated the rigidity of the ribcage if just pushing hard suffices. Though my intentional overestimation of risk prevented that from being a harmful mistake.
That's a good video, and while I'll rethink performing CPR this experience has only reinforced my position of caution in other matters given that if I had attempted CPR prior to this without gaining further knowledge then I would probably have done a hell of a lot of damage to the person via something which isn't very close to CPR and more resembles me attempting to cave their chest in with every ounce of strength I have in my arms (on the, now falsified, assumption that extensive bending of bones was required (or perhaps the false assumption is that ribs are hard to bend in this direction)).
>re legal risk
Would the the aforementioned (now known to just be a) violent beating not attract legal issues because I performed it in good faith? Would a jury even accept that it was in good faith? Are you willing to bet your life on it? Neither was I. As such I would have made the correct decision by deciding not to, in good faith, violently beat their chest in as hard as I could (obviously hugely scaling back the force if it did snap enough ribs to crush inwards). This only makes me more wary of legal risk in other similar situations, since it has made more intuitive the extent of my ignorance of the limits of the body.
While my estimation of the legal risk of CPR is now FAR lower than before, that's largely just because there's far less force involved and less potential for harm if it's just forceful pushing (though perhaps I overestimate the difference in force imparted by a hard push vs a fast moving fist).
>Very unlikely, unless it's a child and you are drunk.
This is only true if one knows roughly how to perform CPR. Given my previous guess at what it was then it probably would have broken ribs if mere pushing suffices to deform them as much as I guess-without-any-good-reason is required.
>perform CPR, not kung fu or whatever that is
The entire point of the post is that guessing what CPR is and doing that is dangerous and irresponsible and that in ignorance the preferred course is often no action (which turned out to be correct since my guess at what CPR was was very, very inaccurate and probably rather harmful).
>No you wouldn't [do more harm]
Given my prior image of CPR, and the fact that apparently the ribcage can be sufficiently compressed (to an extent I have no good reason for believing it is) by just pushing on it rather than hitting it, I rather expect I would have previously done a hell of a lot of harm if I for some reason decided to ignore my caution about guessing how to perform medical procedures and then performing them on nonconsenting strangers.
>You're far more likely to do nothing and let someone die
Sorry, it was intended to be read as:
>I don't know fucking anything, and would probably do WAY more harm than a jury would overlook [if I did ignore my caution and perform my best guess as to what CPR was at the time of writing].
tl;dr: Thanks for the information, there's now a decent chance I'll perform CPR since it looks like it isn't too dangerous compared to my previous image of it. I do not however concede that it's better to guess how to do it if one's as ignorant as I was (unless the chance of death when it's required is really high, which it may be, but a person ignorant of what CPR looks like would also be ignorant of that stat), the only reason my would-be behavior changed is because you provided sufficient information that I wouldn't be guessing anywhere near so much, and the guesses I would make would be regarding a far smaller amount of force than before.
(Score: 2) by FatPhil on Wednesday November 15 2017, @06:11AM (1 child)
Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
(Score: 0) by Anonymous Coward on Wednesday November 15 2017, @07:30AM
>AC
DW, getting corrected on the stupid shit I say without a public black mark is the whole reason I'm AC. I'm very glad my teenage self largely did that, and I assume by the time I'm thirty I'll be similarly relieved my 2- self did the same.
>why the heck did you think that deformation of the ribcage was difficult if the simple act of taking a breath can do it
I'd never considered it before today, but I suppose I assumed it moved incidentally to breathing but didn't deform.
>How can you be so ignorant of your own body?
I literally can't remember the last time I exerted or injured myself beyond a short bike ride or a small cut. I've never broken a bone or even seen (IRL) someone do so, and can't imagine I will any time soon. I discount media representations of injury, on the grounds that Hollywood seems to think head injuries are just cheap sleeping pills, and so can't judge by what I see online and in the media. Literature isn't a suitable source either, for the same reasons. I would guess I properly exerted myself when I last moved house, but with the aid of another I was unable to judge my flesh's work from their's. I do not know what I can lift and what I can't, because I never need to lift anything heavier than a single wooden chair alone. I do not know the relative force of a punch vs a push because I never punch anything, nor push beyond a somewhat stubborn door.
I was shocked at the extent of my ignorance here too for what it's worth.
tl;dr: In the year 5555
Your arms hangin' limp at your sides
Your legs got nothin' to do
Some machine's doin' that for you
(Score: 2) by All Your Lawn Are Belong To Us on Wednesday November 15 2017, @05:23PM (2 children)
Here some answers for you. I am licensed, though not an absolute expert. I have performed CPR.
It is best if you get training. It's not horribly horribly expensive.
FIRST, activate the EMS system. Call 911 (or 999). With that done, you're trying things while waiting for the experts.
If you ever call 911 (which I know is 999 across the pond), the 911 center may try to talk you through doing it if you're willing, because without it the person WILL die. But being trained is much easier.
DO NOT FOLLOW THESE DIRECTIONS. But the operator will tell you: Your hands go center chest between the nipples horizontally and vertically, and lock your elbows so you're pushing straight and full force. (The movies ALWAYS do this wrong because they're really NOT compressing the chest, of course). PUSH HARD, PUSH FAST. 2 compressions per second. You WILL feel the ribcage "give" as the cartilage pops - it will crunch. That's OK. If you're doing it right, it is INCREDIBLY draining, very quickly.
Yes. You are pushing on the sternum hard enough to compress the heart so that blood continues to circulate to the tissues. Flow to the brain is most important, followed by other organs like the liver which need a constant oxygen supply. Rescue breathing is not necessary - if you're not trained it ain't easy to do and survival rates in public are higher without it.
GET AN AED if you possibly can. Turn it on and follow its directions - a 4th grader can use one.
I don't know. That's an interesting question. First, the ribs are actually connected to the spinal column and the sternum bones by cartilage. It is possible that the bones themselves break, but it is far more likely that the cartilage flexes (think a plastic tube that bends rather than breaks.) It sounds and feels like a break even if it's not. It is possible through incorrect hand placement to break the Xiphoid Process (the little tip at the bottom edge of the sternum - you can feel it on yourself.)
Either way, the defense is that it is better to have broken ribs than let a person die.
Ribs break with about 8 lbs. (PSI) of force applied directly. Which ain't much. But again above, you're usually really popping cartilage. If your patient survives, either way, these injuries will heal. Which is better than dead.
You don't slam. You keep contact with the body throughout the stroke, and you let the body recoil (push back) from each compression stroke. And again, cartilage connects them, which IS deisgned to give rather than break a bone, generally.
You stop. For a civilian, ANY sign that shows return of spontaneous circulation (ROSC) is grounds to stop. If the patient starts a regular breathing pattern, STOP. ("STOP" is an EMS mnemonic - Starts breathing, Transfer care, Out of strength (as in exhausted and cannot physically continue due to muscular failure, not "I'm tired," or Physicians order are the four circumstances we stop CPR in.)
No, you KEEP GOING. They will still die if you don't.
The US standard is this: Did you do what a reasonable person would do in the same circumstances? Did you listen for breathing (5-10 seconds) and try to feel for a pulse (even if you don't know how, really.) If you start, did you do everything you knew to try? Did you know that, if you do nothing, the person is dead anyway?
I have zero trust as well. Sooner or later I'll probably be sued. Doesn't change the fact that I have seen someone die in front of me because I didn't know what to do, and I NEVER want to feel that way again. YMMV.
Yep. You have a third option. Think well enough about others to GET TRAINED.
This sig for rent.
(Score: 2) by All Your Lawn Are Belong To Us on Wednesday November 15 2017, @05:33PM (1 child)
Two other things I forgot to mention above. And again, THESE AREN'T INSTRUCTIONS FOR YOU TO DO. I'm not trained in how to give those. But, you are aiming for about 2 inches of compression on an adult - and that's a LOT and takes a LOT of force. And, do it with the patient's back on a SOLID SURFACE. Do NOT compress on a bed or mat - you need hard underneath to resist your compressions and not give. CPR on a bed is useless.
This sig for rent.
(Score: 0) by Anonymous Coward on Thursday November 16 2017, @05:55AM
I intend to find out more because of this thread, and between you and isostatic I've changed my mind and would now attempt to help.