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CPR and Bystander Reluctance

CPR is a daunting prospect even for medical professionals.  Most remember the first time they performed compressions or participated in a code.  For as scary as this situation is for the professional, it is even worse for the bystander who has never faced these problems before.  Maybe they have some training, but they probably forgot most of it.  When stress rises, the ability to recall information that could have been learned up to two years ago often flies out the window.  Bystanders are simply afraid that they can’t be the ones to save a life.

This is where bystander reluctance comes in.  When someone goes down, people are more than willing to dial 911 and wait for assistance.  It is the rare individual who will actually initiate CPR unless they are a professional.  Even when coached by the 911 operator, many bystanders are less than willing to get involved to that extent.  Unfortunately, this means that the likelihood of the person recovering from the arrest with no problems goes down.  The quicker CPR is initiated after someone collapses, the better for the patient.  For this reason, it’s important to explore and understand the background of bystander reluctance.

Possible Reasons for Reluctance

Bystanders have many reasons for reluctance to get involved.  One is simply a question of not knowing what to do.  Even those who have had CPR training may be afraid to actually put those skills to the test in a real life situation.  It is scary to see someone go down, and to step up as someone who knows what to do may be a daunting prospect to your average person.  Another problem is the disgusting factor.  In our culture, we avoid touching, and CPR requires intimate touching of a stranger.  

The mere idea of putting your mouth on another person’s is enough to make bystanders shy away from the whole process.  Fortunately, hands only CPR is making this obsolete, but even pressing down hard on a person’s chest can be frightening.  Finally, bystanders may not be sure of the legalities of getting involved.  They don’t want to be the one doing CPR because they may not do it right.  Some worry about what their liability would be if they did it incorrectly and the person ended up dying.  For most bystanders, it is just easier to wait for paramedics, but this is not in the best interest of the victim.

Hands Only CPR

One concession the American Heart Association has made toward bystander reluctance is the introduction of hands only CPR.  This means that only compressions are called for until the paramedics arrive, and it takes out the additional step of having to give rescue breaths.  Many bystanders are afraid of giving rescue breaths because they don’t have a barrier to protect them from the other person’s mouth.  This is a valid concern that even medical professionals can sometimes face, and hands only CPR cuts out this part of the process.  It simplifies it and makes it culturally more acceptable.

However, these aren’t necessarily the only reasons the hands only CPR has become the recommended line of treatment for bystanders.  In fact, in all of the classes the American Heart Association conducts, compressions are now emphasized far more than they’ve been in the past.  This is because the recovery rate from CPR with adequate compressions is better than the former guidelines.  Although it may seem to some professionals that hands only CPR isn’t as effective, two large studies published in the New England Journal of Medicine have found that it is just as effective as the previous versions of CPR for bystanders.

Advantages of Bystander CPR

The good news is that patients have much better recovery rates when bystanders initiate CPR.  There is less brain damage, a great likelihood of survival, and less heart tissue damage if CPR is started within the first few minutes after arrest.  All of the studies that have looked into bystander CPR have found it more effective than simply waiting for the paramedics.  In essence, there is no down side to bystander CPR, even if their technique isn’t up to professional standards.  CPR by regular people tends to saves lives, and it should be encouraged in the community.

The bad news is that CPR is not performed in many cases, even when 911 operators attempt to talk a person through the steps.  It is estimated that only 15 to 30 percent of out of hospital arrests receive CPR from bystanders before paramedics arrive on the scene.  The fear, the distaste, and the legal ramifications keep most people from performing this lifesaving act.  Even those who are trained with CPR cards are not likely to step up when an emergency presents itself.  Perhaps further education about hands only CPR, the legalities of helping out, and the statistics of survival for bystander CPR patients are the key to convincing more civilians that they can take the chance and save a life.