Imagine: you are on the road and the man standing next to you collapses. What are you doing? If you sign in, you are more likely to end up performing CPR on a man from a woman with the same symptoms. The result: men are more likely to receive CPR than attendees, and so more likely to survive a sudden cardiac arrest. This finding, published last year, garnered a lot of attention from the media at the time, but remains barely understandable. Two studies presented this week at the annual conference of the American Heart Association address the problem and the possible ways to tackle this inequality in care.
"Women have a lower percentage of CPR than those present," says Sarah Perman of the University of Colorado School of Medicine. But no one really knows why it is – although the possible reasons are easy to guess. Perman and her colleagues turned to Amazon's service, Mechanical Turk, for answers. They took the participants $ 1 to answer the open question, "Do you have any ideas about why women are less likely to receive CPR than men when they crash into the public?"
The 54 responses helped to shed light on public perceptions of why this may be the case – although Perman notes that these are just initial results from a small (though national) survey. Another more comprehensive survey is currently being peer reviewed, he says. Its results are in line with what was observed in the preliminary research and was also conducted using the Amazonian Turkish Engineer.
As a clinician says, it is not surprising to see responses citing concerns about accidentally hurting women and the inability to understand how bad a woman's symptoms are. These are both known issues that affect care.
However, "I was surprised by the large percentage of people who responded to unwanted emotion," he says. Respondents have expressed concern that contact with the female chest can be seen as an attack or unwanted sexual intercourse.
"Men do not want to appear in the rape or clumsy placement of their hands on a woman's chest who do not know," one response was read. Another said: "Men are probably afraid of being blamed for some sort of sexual harassment of some sort."
Since false reports of sexual assault are not more common than false references to other forms of crime, this result can tell more about misinterpretations than the real concerns of a person present. But that does not mean it does not bother. "This is not a scenario where a woman is in danger," says Perman. "This is a scenario where a woman is on the ground without a pulse, potentially dead." Since the scenario-one, where a few broken sides are known to be a consequence of CPR and not seen as an attack – was surprised to see this list fear.
In a way, it is not surprising that physicians and other researchers do not really understand what is happening when the attendees make choices about whether or not to provide a CCP. "By definition, sudden cardiac arrest is sudden," says Marion Leary, of the University of Pennsylvania. "We do not know when or where." This means that the study of people's answers in the field is almost impossible.
The student and nurse researcher is the lead author of a document that examines a new method to address this methodological issue. She and her colleagues looked at the response to someone who had a cardiac emergency using virtual reality. Seventy-five participants wore a VR handset and interact with a CPR dummy in a virtual scenario. The dummy was presented randomly either as a male or female and white or non-white.
Looking only at gender, their results showed that people (especially men) were more likely to perform CPR and use an automated external defibrillator in men. As with the first task, however, a larger study is needed to fully understand the trend and understand which sections (if any) are statistically significant and can be used to explain why women are less likely to receive CPR. Further study is also designed to discover the ways in which fight numbers, says Leary.
"I like the use of virtual reality because we can manipulate various factors that we know is a matter," Leary says. However, use of VR may go beyond study and help CPR training become more comprehensive – and therefore more effective. "Right now, it's a kind of one-size-fits-all training program," Leary says. Because issues such as gender and race are not addressed in CPR training and CPR programs use a standard male mannequin to showcase, there is room for concern for different types of bodies to be interpreted and prevent attendees from taking immediate action.
"We want to call 911 people, we want people to perform CPR, we want people to ask and use a mobile AED," he says. Understanding the obstacles that prevent them from taking these vital steps and how to break them down – such as possibly using a VR application to simulate different people suffering from a cardiac arrest in a CPR training class, which its team explores – is important . "Once you uncover these things, the worst thing you can do is not to do it," says Perman.
Correction: An earlier version of this article was mistakenly referred to Leary as a nurse practitioner. She is a nurse researcher.