Why women receive less CPR from bystanders (2018) | Hacker News Reader

Why women receive less CPR from bystanders (2018)

sciencedaily.com

When people believe society doesn't trust them, they'll be less likely to stick their neck out for others. Even if the perception of mistrust is illusory and not backed up by any data, that perception of mistrust will still dissuade altruistic behavior.

For the obvious and purient reason.

Semi-related reasons at least partially explain why the AHA moved away from rescue breaths as part of CPR: they found high rates of total noncompliance because people don’t want to do that. Compressions only turns out to both be fine from a perfusion perspective and also increases bystander participation. I think not taking any breaks for breaths during compressions also reduces clotting, but i’m not sure.

The other reason to not bother with rescue breathing is that AEDs are everywhere now and you’re much more likely to get pads on someone promptly.

Counterpoint, I'm a whitewater rescue instructor. My students and I are much more likely to see drowning victims than heart attack patients. Compression only CPR doesn't help drowning victims at all so we've had to add a "don't listen to your CPR instructor, do rescue breaths first" statement to our classes.

Yep, drowning (and cold water drowning in particular) gets special rules. And a better save rate, iirc…

> The other reason to not bother with rescue breathing is that AEDs are everywhere now

This is a very bold claim that needs a citation with data covering different locations and the number of devices per unit population.

I'm speaking slightly casually. Access to AEDs has expanded in public areas of the region of the world where AHA guidelines for CPR pertain so much that it is reasonable to expect prompt availability to one in the case of sudden cardiac arrest in public, and this has driven updates to CPR guidelines.

Better?

There is nothing obviously prurient about rescue breaths. More often than not, the rescuer will get a mouth full of blood, mucus and vomit for their trouble. There is nothing lascivious or sexual about it.

I agree; rescue breaths into a mouth of bloody vomit is something I avoided in emergency medicine too—with a laryngoscope and a BVM, but that’s because i brought an ambulance with me when i did CPR!

What is purient is the observed disparity between rate of CPR at all as a function of patient sex because tits are involved: ”A small survey found that people may worry that chest compressions by bystanders will seem improper or may hurt women.”

It was my understanding that rescue breaths lower overall compliance, and my comments expounding on it are largely separate from sex-linked concerns.

Early days on this one: "researchers asked 54 people online to explain, with no word limit, why women might be less likely to get CPR when they collapse in public" .. though at least they did use VR to attempt to measure behavior, but concluded: "a study with more participants is needed to statistically identify any significant gender gaps"

It doesn't seem surprising though. We've had stories in the UK where young children have wandered the streets for hours with no members of the public wanting to get involved because of the attitudes around stranger danger.

Unfortunately, it's quite expected. I don't want to get into the debate about whether any of it is true or not, but I believe most agree that lot of the current online narrative either demonizes men or claims that fake sexual harrasment claims are commonplace.

It's not hard to see why being bombarded with such messaging on social media would lead to some people responding to it.

Do you disagree? There is no "innocent until proven guilty" with sexual harassment claims-- it's mostly "off with their head!" and no ability to defend oneself or present or argue evidence. You're tainted for life, regardless of the truth of some situation. Why shouldn't sexual harassment claims be feared?

Nit: In the UK the burden of proof is on the defendant by default. Innocent until proven guilty is a US thing.

I don't think I'd even point the finger at online narratives. I think the behavior we see in day to day life has a bigger effect on how we also behave in public. But maybe I'm being optimistic!

As I just said, I've been a party to and witnessed over a dozen entirely fake sexual harassment claims (those are just the ones where I was there when said harassment was said to have occurred when it didn't). I've actually seen more fake claims than real ones in my life (sorry). So I wouldn't point the finger at online narratives either.

I've been accused of fake sexual harassment. So have most of my friends. I actually think the internet underestimates how frequently it happens.

I have never been accused of sexual harassment, and none of my friends or family have been either.

It seems statistically unlikely that you and most of your friend group have all been accused of sexual harassment if your behavior was unimpeachable.

You seem to be proving the GP's point.

I'm interested in whether the available statistics from law enforcement underestimate how frequently it happens - and how one could possibly find out.

> It doesn't seem surprising though. We've had stories in the UK where young children have wandered the streets for hours with no members of the public wanting to get involved because of the attitudes around stranger danger.

Who would have thought that publicly considering every male to be a (potential) sexual predator would have negative consequences? In any case if you are male and ever in a situation where you consider helping someone but don't because you might be considered a perv or a creep, look for another, preferably female adult and involve them in the effort of helping.

I just remembered something from several years ago. My neighbors had a young boy and girl that were about 12 years old. She was rollerblading in the courtyard of our 8 unit complex. She crashed and started crying and I ran out to check and my brain surprised me. In a short amount of time, it decided she was ok enough not to be severely injured and decided to bail. Her parents came about 30 seconds later. I was always disappointed in myself with that situation but after seeing those stories of kids being manipulated into saying bad stuff happened between them and older people, a young male has to weigh the risks.

If she was dying, I'd do my best to help but if the injury is superficial or just comfort is needed, it's best to wait.

In any case if you are male and ever in a situation where you consider helping someone but don't because you might be considered a perv or a creep, look for another, preferably female adult and involve them in the effort of helping.

I would hope if the situation were grave enough, the instinct to help would just kick in regardless. Like if a kid were hit by a car, most people will want to help if they can. It's the less grave 'grey area' situations where I think people hesitate (which could well include someone in cardiac arrest or maybe having a fit) and teaming up with other strangers seems like a reasonable compromise.

I was thinking about the little girl lost on the street crying. I've been screamed at for walking the same path as a woman and her child mostly because I was male. Always better to have a preferably female Witness with me.

What incentive is there to help at all given the univeral perception of society is that a male who renders assistance they must be, at best a pervert or more likely a 'pedo guy'.

"Teach your child to go to a woman if they are lost. Why? First, if your child selects a woman, it's highly unlikely that the woman will be a sexual predator."

> given the univeral perception of society

The responses to this thread should easily show this is in fact not a universal perception.

FWIW, HN is made up of a small niche of developers and entrepreneurs. It’s hardly representative of broader public sentiment.

And yet, even here there are a number of data points that show that it is, indeed, a strong perception.

Also why men can't work at daycare centres. It is sad one pedo can spoil it for every male.

Here in the UK it's not unheard of, and especially in elementary education there has been a bit of a push to have more male teachers (all my kids have had at least one).

The only flat-out ban I've personally experienced is all my kids are dancers and men are forbidden from being backstage chaperones at the shows. Luckily, I don't want to be one.. :-D

My kids' daycare lets moms and dads volunteer, but only moms help kids in the bathroom. Not because they think the dads are abusers, but because it's far less likely that the moms are abusers. Seems like a strong policy backed by evidence, and both moms and dads support it.

What I'd call an actuarial approach. It's tricky, though, because it can be interpreted as discrimination.

For example, here in the UK young women used to get cheaper car insurance than young men, but this was outlawed – https://www.choose.co.uk/news/women-car-insurance-costs-to-s... (and in an amazing display of transparency, the head of a major insurer said: "As an insurer, I'm pleased. We will raise rates for young women: we won't bring them down much for young men. That means more profit").

There is no emergency where I touch an unconscious woman or get involved with a child where I do not trust the parent.

I don’t even think I would be willing to get involved unless I trusted the witnesses. I’m a socially awkward guy, so if there is a problem I lose by default.

So unless it is friends and family, I don’t know anything medical.

Edit: Unwanted attention

I really lack this angle from their studies. In their later study they conclude that:

"Likewise, said Perman, people need to be assured it's OK to touch a woman you don't know if you are helping someone who might otherwise die"

But that only holds if the risk of getting in trouble is not real. But they don't spend any energy figuring out if this barrier to CPR is imagined or real.

I would argue that, even if you will be falsely accused of a crime, you have a moral obligation to perform CPR because that accusation is so unlikely to go anywhere. I'm sure people make accusations, but from a Google search I can't find any cases where someone was actually arrested or charged for that. It's hard to imagine police or prosecutors not believing that defense, especially given that there would be medical evidence of cardiac arrest.

While it might be the case that it won't go anywhere, as a defendant / accused you still have to deal with possible reputation damage, legal costs, and time loss.

And the other person might have to deal with being dead - totally different magnitude of problem!

I understand why people hesitate, but if someone is dying in front of you, I think you have to do something if you can, consequences be damned.

I kind of feel the same way as OP, even though, as you say, there is little to no evidence of bystanders suffering legal consequences for intervening to help. Despite that fact, it's been hard wired in my brain (and the brains of other well-socialized men) over years that you must never, ever physically touch a stranger, particularly a woman or child. Full stop. Even if they need help, even if they're attacking you, even if they're not paying attention and might walk into you. Never touch. I learned it as a kid, I learned it in grade school through college, and then it's been drilled over and over in every sexual harassment orientation/training at work. It's just a permanent part of my conditioning by now I don't think I could push through even in an emergency. Especially nowadays, where whenever anything happens, 5 cellphone cameras instantly come out, looking for the next viral video. It's too easy to become the next Reddit star in a video maliciously edited to make you look like a creep.

That makes a lot of sense to me - I'm not saying anyone is wrong to have that instinct.

The existence of this instinct makes educating people important. I think that a lot of this issue could be solved by just reminding people during CPR training that CPR is the rare exception to the otherwise good heuristics of "never touch someone without asking them" and "don't rip off strangers' clothes." Using female CPR dolls could also help. And lastly, people need to know that there is no instance of a lay person being successfully sued for performing CPR, there is no instance of someone being "cancelled" for performing CPR, and that in fact the law explicitly protects those who help.

Dead people can't sue you.

Indeed. Frighteningly, when I was trained on how to carry a weapon legally, we were taught to shoot to kill. Both because you never know what a live person with a weapon might still be able to do, and, yes, because a dead person cannot sue you.

This was in a state certified carry permit training course in Tennessee.

I'm not defending it, just saying it happened.

That's pretty standard. The usual argument is that if you are in a situation where you need to pull the trigger, you're not in a situation to risk the other person getting back up. Once you start shooting, you don't stop until the threat is gone. In addition, you aim for center of mass as your accuracy takes a nosedive in a life-or-death situation. You're not likely to hit your target trying to aim for anything else. Even if you are super-duper accurate even under duress, there's really no place to hit a person that isn't potentially life threatening. If you want non-lethal self-defence, a gun isn't what you should reach for.

Exactly. I've had all sorts of training and never been told to aim for anything except center of mass. Also told in CCP training that any trained shooter is trained to keep firing until their clip is empty.

Neither can alive people apparently because I have not been able to find a case where someone actually sued the person who performed CPR on them.

Edit: It won't let me reply to the link below but that has absolutely nothing to do with gender. That's about injuries sustained while performing CPR and, to quote the article, "You're more likely to get sued if you don't intervene" and "no non-medical person has been successfully sued for providing bystander CPR."

Of the three cases in which defendants were charged with battery assault because they did administer CPR, only one was convicted. And that was because "the patient already had a signed 'Do Not Resuscitate' order and received CPR anyway in their nursing home,"

But most states fully protect bystanders who sincerely try to help, Murphy stressed. Some states even have "Duty to Act" laws that establish fines specifically for bystanders who are medically trained to provide CPR but choose not to help when an emergency unfolds. (Minnesota, Rhode Island and Vermont are three such examples.)

https://www.webmd.com/first-aid/news/20191112/you-wont-get-s...

Absolutely not. The damage to your reputation, the real chance of losing your job, your family, plus the cost and time defending yourself....absolutely not worth it.

According to the CDC, performing CPR has a 10 to 20% chance of saving someone who would otherwise die (https://www.cdc.gov/heartdisease/cpr.htm)

In contrast, there are no documented cases of someone experiencing actual negative consequences from performing CPR. No lost jobs, no nights in jail, nothing. The closest thing I could find was a case in Japan where a man was questioned by police and let go as soon as he explained that he was using and AED (https://japantoday.com/category/national/man-revives-woman-w...). It was in the unusual case where he performed AED outside, where many passers by were driving and didn't have time to see what was actually happening. Even then, nothing bad happened to him and he saved someones life.

There's a great saying I've learned in life:

"Perception is reality"

Try again.

I genuinely don't understand what you mean. Are you saying that the man in that case suffered negative consequences because others perceived him negatively? I would argue that, in the end, others perceived him positively, as evidenced by the fact that there are news articles lauding him.

Edit: Seems like I've maxed out the conversation tree depth so I'll reply via edit. I absolutely agree, and I think it's therefore important to educate people and let them know that this has never happened and, if it did, the legal system would have their back.

I'm not saying I don't believe the medic above, I'm sure people make accusations. And if you're performing CPR all the time, having a partner with you absolutely makes sense for more reasons than one. However, there is no evidence that any of those claims has ever gone anywhere, or that it's a relevant issue for us non-medical people who are unlikely to perform CPR more than once in our lives.

No. That even if you cannot find a recorded incident, there is the perception they occur (and the medic above said they do occur). That perception is what guides people's beliefs that they may be accused and the fear.

The law in Germany mandates that you have to help (§323c StGB), and gives you a "Haftungsprivileg" for this situation, making you less liable if you do something wrong. It even goes further, if you suffer damages during giving first aid, you are eligible for compensation. Everything within the appropiate limits, of course.

Good law!

> you have a moral obligation to perform CPR

I think that's a dodgy claim, but suppose it's true and you convince everybody that it's true: We know people aren't actually perfect moral decision makers. Even if you manage to convince everybody in the world they have a moral imperative to help, people are still people. At least some of them will put their own skin before their moral imperative to render assistance. Every day, people around the world do things they personally believe to be immoral because they stand to profit from it. Scolding people about their moral obligations hasn't solved crime, and I don't think it ever will.

Anyway, I said I think it's a dodgy claim. Here's why; we can generalize that moral assertion to people having a moral duty to render assistance despite the risk to themselves. But obviously there must be limits to this, the magnitude of the risk is vital to the question. Do you, a casual bystander, have a moral duty to run into a burning building to save somebody? Sometimes people choose to do this and manage to save somebody; obviously they're heroes. But is there a moral obligation for you to run into a burning building, without any firefighting gear or training? Obviously not, the risk is enormous. So the moral duty to render assistance must depend on the magnitude of the risk. But where you put the threshold is entirely subjective and a personal judgement call. Some people have families to support, while other people have nothing to lose. How can you draw one line for both? Some people have a very good reason to believe society distrusts them and will believe the worst in any ambiguous situation. Somebody who's well respected in their community can likely tolerate more risk than somebody who lives on the fringes, maybe has a few criminal convictions in their past, belongs to a demographic popularly discriminated against, etc, etc.

Hypothetical: I'm a single parent with 3 kids to support and a criminal conviction in my past, time served and debt to society payed. I have a lot to lose, three kids that depend on me and will likely get abused in the foster system if I get arrested again. And because this hypothetical me has a criminal record, I know that the system and society are strongly biased against me. Society doesn't really trust me, even though I served my time and payed my debt to society. Do I have a moral duty to help somebody else? Perhaps. But I also have a moral duty to provide for my kids. These factors dissuade me from rendering assistance even if you convince me this moral imperative exists.

Most men accused of bad behaviour never see a courtroom.

These two angles are not mutually exclusive.

You'll have to explain yourself. What is not mutually exclusive?

The fact that random bystanders and experienced staff in certain situations both have reservations about giving CPR to women.

"you remove all clothing and move jewellery away from the site"

As a SAR medic because you're setting up for defibrillation. For the public its fine to do minimal exposure; You can figure out CPR hand position through the patient's shirt.

Edit: Unwanted attention

I was specifically trained to remove bra, because it restrains chest and breaks ventilation (the air will go to the stomach instead and inflated stomach will block further air from entering the lungs). I can imagine this might be seen as inappropriate for a bystander who doesn't understand how this works, but there's something wrong with the system if that might cause serious complaints against rescuer.

Do you have any interesting statistics or official training related to your experiences, or is it word of mouth & personal anecdotes?

I can report finding your comment more interesting than the article. This study seems underexplained and it is hard for me to work out what they actually did and whether the results were because of different symptoms of heart attacks between the genders. There seems to be discussion of hypotheticals and mashing different studies together in ways that aren't justified.

I wonder if CPR training dolls were to made female, whether that would improve matters?

It would at least force you to deal with the question of breasts during training.

At least one major brand does exactly that. https://laerdal.com/gb/doc/2404/Resusci-Anne-QCPR

ResusciAnnie has been the gold standard CPR mannequin since at least the early 90s when I first learned CPR at my local fire station. In fact, I don't think I've ever seen a CPR mannequin that wasn't based on Annie.

I always thought it was resussannie ?

I can’t say for certain how I would act in such a situation, but I like to think I would provide CPR regardless of gender. However I can certainly see the point that a man would be very hesitant to provide aid to a woman in this…time of easy misunderstanding.

One never knows till one is in the moment. I watched a wave grab a child. As it happened we both came back out, but it was neither or both, that's how we're wired.

As a professor one of my students had a seizure then stopped breathing, during one of my exams. There were fifty students closer to her than me, yet somehow I found myself giving aid, as everyone else either dialed 911 or swooned "there goes my professor!" There was that second where all these thoughts went through my mind, but then she started breathing.

As for false accusations, there's a principle that accusers should understand but don't: NEVER assume you're the craziest person in the room.

As a former outdoorsman I’ve been in situations where I had to rush to a potentially critically injured near-stranger, and other situations where I was startled by a large wild animal, and as far as I can tell it’s the same response. My rational mind simply disengaged like a clutch, and it was barely even informed of what I was doing until minutes later. My memory says my body was moving without my help. I’m usually the one who’s calm and troubleshooting like a robot while others are freaking out, but when the brain decides it’s time for an adrenaline flood I believe that trumps every other thing.

Yeah, that instant reaction is very primal(?) for everyone. Everyone has ideas but most of the time your higher level thoughts aren't even operating. It's just instinct.

I was on a plane once where a man donned a helmet and knee pads and attempted to open the door to the outside. I'm know that is an impossibility in the air, but instinct says stop it. Several men charged the guy and held him down until the flight touched down but it was interesting to see the reactions from various people.

Easy solution: train more women in CPR.

Also, many airports now have CPR training stations where you can practice on a dummy while you wait for your flight. Please try one, I found it very informative!

I specially agree with the two first reasons listed in the article. I do have certified first aid and CPR training but the wellbeing of my family comes first, I am not going to get charged with attempted rape and/or cancelled because I wanted to be a good samaritan.

I've done a lot of searching after reading this article and I couldn't find a case where a man was charged with a crime or canceled for performing CPR or using an AED.

The closest I could find was this case in Japan, where someone was let go by police the minute he told them he was using an AED (https://japantoday.com/category/national/man-revives-woman-w...).

It doesn't matter if there is evidence or not, if statistically, women are treated less the issue is real and there needs to be a social/public push to make it appropriate.

There needs to be a law similar to good Samaritan that allows for men to touch women during CPR without fear of reprisal.

Those laws exist in almost every state, where Good Samaritan laws specify that consent to CPR is implied if a victim is unresponsive. Consent is implied for children who are unresponsive if their parent is not present. https://americancpr.com/blog/tag/good-samaritan-act-good-sam...

States should add those laws where they are absent and clarify them where they are vague.

Thanks for this!

My personal perspective is that if you are performing CPR on me and saving my life, you're forgiven if you want to touch my junk, steal my watch or accidentally break a rib.

Sexual harassment accusation?

Edit: So as I thought: "In the replies, the team identified four themes:

Potentially inappropriate touching or exposure;

Fear of being accused of sexual assault;

Fear of causing physical injury;

Poor recognition of women in cardiac arrest -- specifically a perception that women are less likely to have heart problems, or may be overdramatizing or "faking" an incident;

The misconception that breasts make CPR more challenging."

This lacks a year in the title.

They continued their research, with their next study having +500 participants. It's mechanical turk participants though.

https://www.ahajournals.org/doi/10.1161/circ.142.suppl_4.139

, now lie in it.

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