By: Meriah Long
mlong@mbayaq.org
Have you ever noticed that when training CPR we use mannequins named “Little Anne” who have a woman’s face and a man’s torso? This is the standard mannequin that we have all practiced on. While they have undergone quite a few evolutions since they were first invented in the 1950s by toy maker Asmund Laerdal, one thing that has somehow never appeared on these mannequins are breasts. For a mannequin with the name “Little Anne,” this oddity is very rarely questioned. This choice was made because Laerdal was worried that male students would be hesitant to practice mouth to mouth on a mannequin with a male face. When searching for a reason why a female equivalent wasn’t also made, the answer simply doesn’t exist. A need for a female mannequin for training CPR was simply never perceived. While mannequins alone are not the cause they are one part of a much bigger issue: societally ingrained gender-bias and its effect on a responder’s ability to provide care to victims with breasts.
There is a pre-existing gender bias that unfortunately results in female victims receiving lower levels of care and therefore having a higher chance of dying when experiencing a cardiac incident. In the study “Gender disparities among adult recipients of bystander cardiopulmonary resuscitation in the public” that was published in 2018, researchers pooled together approximated 20,000 cases of cardiac arrest outside of the hospital setting and found that 45% of men received CPR and only 39% of women. Overall, men had a 23% higher odds of survival. In conclusion, they state that the study shows that women experiencing cardiac arrest are less likely to get the CPR they need compared to men, especially if the emergency happens in public. 23% is an upsetting reality to face, but we have the ability to acknowledge its existence and start a discussion amongst instructors and students alike on why it exists and who it affects.
The study “Public perceptions on why women receive less bystander cardiopulmonary resuscitation than men in out-of-hospital cardiac arrest” published in 2019 discovered the three most common answers to this exact question. Those were: sexualization of women’s bodies, the perception that women are weak and frail and therefore prone to injury, and misconceptions about women in acute medical distress.
First, misconceptions of women’s bodies: members of the general public perceive fears about inappropriate touching and accusations of sexual assault. The result of this is that there is a hesitation to administer care to a provider’s fullest extent…if at all. We unfortunately live in a culture that has hypersexualized the female body and has created a sense of taboo surrounding it. Because of this a sense of hesitation is now common amongst responders. And while we haven’t been able to demystify the taboo surrounding the female form, we can acknowledge that it exists and educate responders that laws have been put in place to protect against accusations where a person is providing medical care. Remember, “it isn’t a social occasion. It’s a medical emergency”. The best way to tackle this issue is to talk about it, by not discussing the issue we reinforce that it is taboo.
Next, the perception that women are weak and frail and therefore prone to injury: is a cultural perception that women are weaker and more easily injured than men. The result of this is that responders who do choose to help female victims may not provide proficient care out of fear of causing injury. Specifically this comes into play with the quality of compressions during CPR. We are taught that compressions should be 2 inches deep and that we will most likely break ribs in the process. That fact is still true when providing care for a victim with breasts. We can all agree that being injured is always better than dead. But, because responders are never trained on a mannequin with breast there is no muscle memory to fall back on. No repetition ingrained in us to do the exact same thing that we would on a victim without breasts.
Lastly, misconceptions about women in acute medical distress: women can experience medical distress in ways that present differently than men. Not only may their symptoms be questioned because they may be different than that of a male, but it is an unfortunate fact that a woman’s pain or symptoms are commonly discredited and not taken with the seriousness they deserve. Because we don’t discuss these differences, responders may not recognize the signs and symptoms that are common to women and not men. As with men, women’s symptoms are chest pain and discomfort. But, women may also experience other symptoms that are less typically associated with heart attack, such as shortness of breath, nausea/vomiting, and back or jaw pain. These are all symptoms that students aren’t being taught to recognize as signs of cardiac arrest.
While it might seem like the odds are stacked against changing this paradigm, we have an opportunity now to be better and we can take it. So, what can we do to change this? We can start by acknowledging this bias exists. When people know better, they do better. We can also create a dialogue; since we understand the public perceptions that exist, we can counter them with real data, information, and training. Lastly, we can update training equipment to reflect different bodies, with the goal to eliminate hesitation by making training as realistic as possible. By altering equipment and creating a safe space for discussion we can engage with the class on the issue and make them aware of the differences that may be present when performing CPR and applying an AED to a victim with breasts. The differences in care aren’t drastic. But if we train students to be prepared for these differences by acknowledging and discussing them, we can start the process of gaining muscle memory and diminishing hesitation to respond properly to any person in need. By raising awareness of bystander CPR and talking about issues surrounding gender disparities when responding to sudden cardiac emergencies we can work together to make our community safer for all.
Works Cited
Blewer, Audrey L., et al. “Gender disparities among adult recipients of bystander cardiopulmonary resuscitation in the public.” Circulation: Cardiovascular Quality and Outcomes, vol. 11, no. 8, Aug. 2018, https://doi.org/10.1161/circoutcomes.118.004710.
Caitlin Tilley, Health Reporter For Dailymail.Com. “When Political Correctness Becomes Deadly: Study Finds Women Are Less Likely to Be given CPR than Men in Public Places – and It May Because It’s Seen as ‘Creepy.’” Daily Mail Online, Associated Newspapers, 17 Sept. 2023, https://www.dailymail.co.uk/health/article-12524015/Women-likely-given-CPR-men-inappropriate.html.
“CPR Can Save a Woman’s Life.” Www.Goredforwomen.Org, 20 Feb. 2024, https://www.goredforwomen.org/en/about-heart-disease-in-women/facts/cpr-can-save-a-womans-life.
Perman, Sarah M., et al. “Public perceptions on why women receive less bystander cardiopulmonary resuscitation than men in out-of-hospital cardiac arrest.” Circulation, vol. 139, no. 8, 19 Feb. 2019, pp. 1060–1068, https://doi.org/10.1161/circulationaha.118.037692.
“Women Are Less Likely to Receive Help during a Cardiac Arrest Emergency.” HSI, https://hsi.com/solutions/cpr-aed-first-aid-training/resources-media/blog/women-are-less-likely-to-receive-help-during-a-cardiac-arrest-emergency. Accessed 1 June 2023.
“Women Less Likely to Be given CPR than Men in Public Places.” EurekAlert!, https://www.eurekalert.org/news-releases/1001384. Accessed 1 June 2023.
“Women Less Likely to Receive Bystander CPR during Sudden Cardiac Arrest.” AED Superstore Blog, 11 Mar. 2022, https://www.aedsuperstore.com/blogs/cpr-on-women/.
