(Updated January 28, 2024)
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 .
This statistic is heartbreaking and something has to be done to dispel the myth that we have to remove the clothes to begin compressions. When the AED arrives, after turning it on the prompt says, “remove clothes” , but removing the clothes of a woman, or a man just isn’t necessary in public settings until the AED arrives.
In most CPR training classes the shirt is already off when you enter the class. in real life this is unreasonable to ask anyone to remove the clothes of a woman, or a man that you don’t know. 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 either a woman, or a man. The only time a person could comfortably remove a person’s clothes if it was a person that they are intimate with. I often present this question in our CPR classes. Which would be harder for you to do? Removing the clothes of your aunt, uncle, cousins, or grandparents compared to a total stranger? Both would be extremely difficult to do!
This video produced by this Sarver Heart Center in Arizona expresses that the clothes should remain on when initiating compressions only CPR. What a great start to improving survival rates with Bystander CPR.
You can not hurt someone doing CPR on them, but your inaction to do so certainly will. 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).
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, and without medical shears.
Adding to this confusion most of the manikins used in CPR classes are shirtless males. At Revive CPR our manakins are wearing T-shirts with Bay Area sports teams. After all, we are saving people, not manikins.
Beginning with the next AHA update in 2025 the AHA will be requiring training Centers/Sites to have at least one female mannequin. This is a great breakthrough to help save more women’s lives!
Is it necessary to remove the clothes to start CPR, or can you be accused of sexual misconduct if you do? Absolutely not, but Im sure you would agree that it’s a lot less shocking if you leave the clothes on. As long as you begin Compressions quickly a person has the best chance of survival until EMTs arrive.
Tip: How to find the correct hand-placement for CPR through clothes.
The most common mistake that we notice as instructors in CPR classes is incorrect hand placement. Often times this mistake happens repeatedly even by medical professionals who have been certified many times before. 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, yikes.
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 back a few inches 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’.
Roy Gordon, EMT/ AHA CPR Instructor
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