(Updated Sep 5th, 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 [1].
For the last sixty years since CPR training curriculums were first established by the AHA in 1963, CPR training curriculums instructions have been to remove the clothes before beginning compressions. Now, the recommendation is to leave clothes on for bystanders until the defibrillator arrives.
Thankfully, now The Sarver Heart Center in Arizona, and The American Heart Association (AHA) are taking steps to shorten the survival rate gap between men and women, and to bring more awareness to this discrepancy, when the AHA updates their guidelines in April 2025, all AHA training sites will be required to have at least one female manikin for training.
We are looking forward to the female manikin arriving to our training center, as this will bring a whole new level of awareness that saving a woman with CPR is no different then the technique that is used for a man.
The video below produced by this Sarver Heart Center in Arizona reinforces leaving clothes on when providing chest compressions until the AED (Automated External Defibrillator) arrives. Also, The American Heart Association made this update to their Heartsaver online CPR/AED, and First aid course expressing to leave the clothes on until the defibrillator arrives. This creates less confusion, saves time, and adds a layer of protection between the rescuer, and the patient until the gloves arrive in the AED rescue kit that is attached.
Whether the clothes are left on, or off as long as you begin Compressions quickly a person has the best chance of survival until EMTs arrive, however, I am sure you would agree that it’s a lot less shocking, and takes less time to perform compressions through the clothing.
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.
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’.
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Roy Gordon, AHA CPR instructor/EMT
Revive CPR 148 Townsend St., San Francisco, CA 94107
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