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  • Why people fear performing CPR on women – and what to do about it

Why people fear performing CPR on women – and what to do about it

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Contributor: American Heart Association

Women are less likely than men to receive CPR from a bystander. But why?

The reluctance, new research suggests, may be fueled by worries of being accused of sexual assault or doing physical harm. Knowing people’s secret fears is the first step to dispelling them, experts say.

The insights come from a new survey of 520 men and women who were asked to rank potential reasons someone might not want to provide bystander CPR to a woman, based on the sex of the rescuer. The survey built upon previous findings from the same research team that had respondents use their own words to describe why someone might hesitate to provide lifesaving care to a stranger.

The new survey compiled the open-ended responses into themes, which respondents were asked to rank. Both men and women said the biggest reason male rescuers would refrain from giving CPR to a woman was fear of being accused of sexual assault or inappropriate touching, whereas the biggest reason a female rescuer might not provide assistance was fear of harming the victim. Less often, respondents said a male or female rescuer might have a misconception that women don’t have cardiac arrests or think a woman was being overdramatic.

The research was presented earlier this month at the American Heart Association’s virtual Resuscitation Science Symposium. It is considered preliminary until published in a peer-reviewed journal.

“Hopefully, this information can be used to help us eliminate the biases that people may have,” said Shelby Shelton, a professional research assistant at the University of Colorado Department of Emergency Medicine and one of the investigators.

More than 350,000 sudden cardiac arrests occur outside the hospital each year, according to AHA statistics. Though the vast majority of these occur at home, about 19% in adults and 13% in children happen in public. Bystander CPR can double or triple a person’s chances of survival if started immediately.

But women are less likely to get such help. A 2018 study published in Circulation: Cardiovascular Quality and Outcomes found 45% of men received bystander CPR compared with only 39% of women. Men had 23% higher odds of survival than women.

“Everyone deserves to get CPR and a chance at a great outcome when they collapse in public,” Shelton said. “We want to encourage strong public education around that core message.”

In the new study, researchers were surprised to find that men and women shared the same perceptions of what might deter a rescuer, said Dr. Sarah Perman, the study’s senior investigator and an emergency physician. She is an associate professor of emergency medicine at the University of Colorado School of Medicine. Respondents were asked how they perceived others might feel giving a woman CPR, rather than about their own feelings, to remove any reluctance to answer honestly.

Framing the question that way “could help uncover those hidden fears that people may have,” said Dr. Ashish Panchal, a professor of emergency medicine at the Ohio State University Wexner Medical Center, who was not involved in the study. “And if we have a better idea of these underlying, hidden feelings that people might feel uncomfortable talking about, it gives us a better idea of how to train people.”

For example, he said, “the probability of injury from bystander CPR is really, really low. Knowing the perception is there that helping someone might hurt them, we now know we have to combat this.”

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. “A woman at the gym or the grocery store who is in medical distress is clearly a scenario that warrants public assistance,” she said.

This type of data also could be useful for training 911 dispatchers, Panchal said. “These are the people who are giving instructions that guide people to perform CPR in real time. If they understand the fears people have, they can help to dispel those fears as they are guiding someone on the phone about what they need to do.”

For more information about CPR and Workforce Training, visit https://cpr.heart.org/en/training-programs/workforce-training

Jacqueline "Jackie" Annis is an industrial hygienist with the Office of Partnerships and Recognition, Directorate of Cooperative and State Programs in OSHA’s National Office.  Jackie’s primary responsibilities include developing and overseeing internal policies and procedures for the VPP, reviewing VPP on-site evaluation reports for process safety management information, serving as the National Office liaison for two of OSHA’s ten Regions, and facilitating the management of OSHA’s National Strategic Partnership Program.  She is an integral part of OSHA’s National Office team. 

She has served with the Agency for 36 years, including five years as a senior industrial hygienist in OSHA’s Office of Health Enforcement, Directorate of Enforcement Programs in the National Office and 17 years as a compliance safety and health officer in the Denver, CO Area Office.  Prior to her tenure at OSHA, Jackie worked as an industrial hygienist for the Department of the Navy in Alameda, California.  Jackie obtained a Bachelor of Science degree from Old Dominion University in Norfolk, VA in 1983.

Wayne Howard earned a B.S. in Chemical Engineering from UC Davis and has spent 12 years with Shell (at Martinez) refinery, 3 years with the consulting firm Process Safety, 15 years with Valero (at Benicia), and the last 10 years in the Corporate Process Safety Department. He is the Valero representative to AFPM's Advancing Process Safety Initiative.

Nathan Obaugh, PE is a senior engineer in the Safety and Operational Excellence Group at NuStar Energy. Nathan has over 10 years of PSM and process design experience in the petrochemical, refining and midstream industries. At NuStar, Nathan oversees all elements of the corporate PSM program and works directly on hazard analysis, process safety studies, PSM/RMP audits and provides process engineering support to the operations and capital projects groups.

Jared Teter, PhD is a senior staff scientist with a background in physics and hazards analysis. He has extensive experience in subscale testing of energetic materials and has served as program manager for several large testing and risk management projects. He has applied engineering and risk management protocols while evaluating the risk associated with propellant and explosives manufacturing, combustible dust, and other hazardous material related processes.

Tim Belitz has a degree in Environmental Health/Industrial Hygiene from Old Dominion University and a Master’s from Duke University. He has over 25 years of Industrial Health Safety and Environmental Experience and is a Certified Safety Professional. He has many years focused on Contractor Management and Process Safety programs.

Rob Walker graduated from Virginia Tech in Microbiology and Chemical Engineering. Rob has almost 35 years of experience working in the chemical plant and refining industry. His passion for Process Safety and Mechanical Integrity began very early in his career. Rob began with his current company, Honeywell, back in 2011.

Prasad Joshi has B.S. and M.S. Degrees in Chemical Engineering from two universities in India. Prasad has over 30 years’ experience in the business. He began with Honeywell in May 2022 as Principal Maintenance Engineer. He has worked internationally in Asia and Europe.