A woman jogger suddenly collapses in front of you in a park and there is no one else around. After phoning 911 on your cell speakerphone you check for breathing for ten seconds. She is not breathing, or only gasping. What you do next depends on whether you are a man or a woman.
According to a recent survey from the American Heart Association (AHA), men who suffer out-of-hospital cardiac arrest in a public location receive cardiopulmonary resuscitation (CPR) from a bystander 45% of the time. Women, in comparison, receive bystander CPR in only 39% of cases. As a result, men have a 23% higher survival rate [1].
This statistic is heartbreaking and something has to be done to dispel the myth that we have to remove the clothes to begin compressions. Yes, it is true that the clothes above the waist need to be removed when the AED arrives so the defibrillator pads will stick, and EMTs always expose the chest when they arrive, but removing a woman’s clothes and brassiere just isn’t necessary until that point.
In most CPR training videos the shirts are torn-off a man to begin Compressions. This is unreasonable to ask anyone to tear the clothes off a woman, or a man. As if performing CPR on a stranger isn’t foreign enough? Not providing an option to leave the clothes on until the AED arrives creates a lot of confusion on how to proceed, and/or reluctance to perform CPR by a man.
You can not hurt someone doing continuous compressions on them, but you’re inaction to do so certainly will. EMT’s depend on bystanders to start compressions right away, otherwise they hardly ever stand a chance to successfully revive someone. Anything you do will help. Half of something is better than all of nothing!
Both The American Heart Association and the Red Cross should be emphatically stating in training videos and materials to start compressions with the clothes on. The Sarver Heart Center at the University of Arizona is doing just that. Please watch the video below explaining continuous chest compression (Hands-Only CPR). They clearly state that the persons clothing is not removed.
If both The AHA and The Red Cross mentioned starting compressions with the clothes on in CPR training curriculums there would be an immediate effect on improving a woman’s odds to get help from bystanders in public. Additionally, since we should only take ten seconds to remove the clothes to start compressions it is unreasonable to think that a person could do this quickly enough. especially in the winter.
Adding to this confusion all of the manikins used in CPR classes are male, and the first thing you notice when walking in the classroom is that they all are shirtless and in perfect shape. We offer more realism in our CPR certification classes so all of our manikins are wearing clothes well, T-shirts at least with Bay Area sports teams. After all, we are saving people, not manikins. As far as I know they don’t even make a female manikin for CPR training classes. Every CPR training class should be required to have at least one female manikin. I am sure that in Europe there is a lot more discussion about saving women and they are not so Inhibited about discussing the matter.
Is it necessary to remove the clothes to start CPR? No. Can you be accused of improper touching or sexual misconduct if you do? Absolutely not. But I’m sure you would agree that it’s a lot less crazy if you leave her clothes on. Either leaving a persons clothes on, or taking them off is fine as long as you begin Compressions quickly a person has the best chance of survival until EMTs arrive.
Finding the correct hand placement for compresions through clothes
Pushing hard and fast In the center of the chest is key. Getting CPR certified every two years is essential. The most common mistake that we notice as instructors in CPR classes is incorrect hand placement. Oftentimes this mistake happens repeatedly even by medical professionals who have been certified many times.
If you are too low on the sternum the tip (Xiphoid Process) will break off, and instead of pumping their heart you would be pumping the liver. To find the correct hand placement with clothing on, or off, reach across to the opposite side of the person under their armpit and then bring the heal of your hand a few inches back to the center of the chest over the sternum.
Try it on yourself and you will see that you can feel the sternum through clothes. If you are unable to feel the sternum through a brassiere, then it would be necessary to remove the clothes. This technique puts the heel of your hand directly on the sternum over the heart, and when done correctly on a woman your hand will be touching her breast. Knowing this information in CPR training classes could certainly help men understand what to expect, and that any woman would be fine with ‘her life in your hands’.
By Roy Gordon, NREMT/ BLS, CPR Instructor
Revive CPR Training San Francisco
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