Yes, they absolutely do. It is surprising to learn that women who suffer cardiac arrest outside of a hospital receive bystander CPR less often than men, even though it is a proven intervention associated with improved rates of survival with good neurological recovery, according to the Journal of the American Medical Association, JAMA.[i]

According to research, women received CPR in 39% of witnessed instances of collapse whereas men received CPR in 45% of their cases. That may not sound like much, but it definitely impacts survival with men surviving at a higher rate. A study in the American Heart Association magazine, Circulation, provided some surprising insights into what is driving this lesser rate of CPR for women. The results were eye opening. The Public Perceptions On Why Women Receive Less Bystander Cardiopulmonary Resuscitation Than Men in Out of Hospital Cardiac Arrest[ii] study involved a national survey of over 580 participants across the United States. Participants were evenly split between male and female with almost 42% trained in CPR. They answered a series of 12 questions on the topic with one free form text question included.

The free form text question was:

“From studies, we know that women receive bystander CPR less often than men. Do you have any ideas on why women may be less likely to receive CPR when they collapse in public?”

Three main themes emerged from the answers.

1. The sexualization of women’s bodies. Fear of being accused of inappropriate touch, even sexual assault, exposed breasts and mouth to mouth had sexual overtones that could prohibit intervention.
2. Women are perceived as physically weak or fragile – afraid to further injure the person was cited as well as being accused of nonsexual assault was noted in the findings.
3. Lastly, there is a misperception about women and “acute medical distress”, particularly cardiac arrest and cardiac disease. “People don’t expect women to have heart attacks” was one quote. Also included in this category were quite a few (26) notations that women are perceived to be “emotional, overdramatic and faking it”.

For all these reasons, women are approached less than men with the lifesaving intervention of CPR.

Other findings in the study shed light on the perception that most CPR providers were male, which likely feeds the sexualization finding. An Austrian study also found that women were less willing to provide bystander CPR or to apply an automated external defibrillator to a person who had collapsed from cardiac arrest. [iii]

So how do we as a society address this disparity?

One suggestion is that we seek to increase the understanding of cardiac health and presenting symptoms in women. These can differ quite remarkably to the accepted male standard of left arm pain, diaphoresis and chest pain. Another area that might mitigate this phenomenon is to encourage, empower and educate more women to learn and provide bystander CPR. As more women are empowered to provide CPR, the mental model of the male provider would lessen.

Additionally, efforts are underway to increase CPR training in a variety of formats. Mandating CPR training for graduating high school seniors and 911 dispatcher assisted efforts are all being rolled out. But additional work is needed to communicate an oppositional message to the sexual assault/further injury mental models. This will take time and policy if CPR is to be provided at an even rate by both male and female interventionists.

One thing you don’t want to happen is for training not to prepare either sex for the actual provision of CPR in the field. If we are cognizant of all these emotions swirling on top of an emergency situation, training needs to be rethought to ensure it is full throated and realistic. This is two fold: the actual simulation of providing care as well as the inclusion of these very important social determinants of care provision in teaching.

TCS Female Trauma Simulator

On the simulation front, Operative Experience Inc. (OEI) is the first medical simulation company to have developed a fully realistic anatomically accurate female trauma simulator. In addition, OEI’s new suite of realistic female trauma simulators also bring a more ethnically diverse training experience being available in African American, Caucasian and Hispanic skin tones for a more true to life training experience to better prepare both first responders and the public in emergency life or death experiences.

Operative Experience’s fully lifelike female simulators provide the gold standard in cardiac and respiratory disorder training approaches. With lifelike skin, realistic body weight and body presentation, the Female TCS simulator is designed to present a realistic female “patient”. With realistic heart sounds, lung sounds, and airway sounds, these simulators provide comprehensive ACLS and ALS training for academic programs, hospitals and emergency care services.

The TCS Plus version of this simulator also provides for a remote controlled respiratory rate, remote controlled heart rate, defibrillation, cardioversion and pacing. This allows for changes in condition that force the care provider to think and change course if need be.

The use of a high fidelity, fully realistic female simulator is a good first step in helping learners navigate a high stakes emergency situation with care and finesse. But it is only part of the equation.

For society to truly combat outdated attitudes and ultimately save more female lives, all training programs need to include surprising research such as this. Help students confront and understand their own biases that may exist by being open and honest in discussions around this topic. Stress the disparity in outcomes – real lives – that these outdated mental models impact. Help students see what they may be feeling or experiencing in an emergency situation with an unknown female.

Instruction on the different ways women and men present with cardiac symptoms should be stressed. An effort to recruit female responders should be considered with specific instruction as to why female responders are so vital in this regard.

The study concludes “we must strive to increase overall rates of CPR in US communities while reducing the differences observed between men and women”.

Operative Experience is proud to provide the simulation expertise that can contribute to ultimately equalizing outcomes for men and women with out-of-hospital cardiac arrest. Operative Experience is also equally dedicated to raising awareness about this life or death disparity and is working to provide information such as this study to help impact training and policy.

References

[i] Bobrow BJ, Spaite DW, Berg RA, Stolz U, Sanders AB, Kern KB, Vadebon-coeur TF, Clark LL, Gallagher JV, Stapczynski JS, LoVecchio F, Mullins TJ,
Humble WO, Ewy GA. Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA. 2010;304:1447–1454.
doi: 10.1001/jama.2010.1392.[ii] Perman, S, et.al., Public Perceptions On Why Women Receive Less Bystander Cardiopulmonary Resuscitation Than Men in Out of Hospital Cardiac
Arrest, Circulation. 2019;139:1060–1068. DOI: 0.1161/CIRCULATIONAHA.118.037692[iii] Krammel M, Schnaubelt S, Weidenauer D, Winnisch M, Steininger M, Eichelter J, Hamp T, van Tulder R, Sulzgruber P. Gender and age-specific
aspects of awareness and knowledge in basic life support. PLoS One. 2018;13:e0198918. doi: 10.1371/journal.pone.0198918.